[Midarm arteriovenous fistula: single-center experience]

Area of Science:

• Nephrology
• Vascular Surgery
• Vascular Access

Context:

• Radiocephalic arteriovenous fistulas (AVFs) on the wrist are standard for hemodialysis but have limited survival in older patients with diabetes or severe vascular disease.
• The growing prevalence of these comorbidities necessitates alternative vascular access strategies.
• Distal AVFs frequently fail in this patient population, leading to a need for secondary or alternative access methods.

Purpose:

• To evaluate the efficacy and survival of midarm arteriovenous fistulas (AVFs) created using the proximal radial artery.
• To assess the midarm AVF as a primary or secondary vascular access option in patients with challenging vascular conditions.
• To compare the outcomes of midarm AVFs with traditional distal AVFs in specific patient cohorts.

Summary:

• Nineteen midarm AVFs were created using the proximal radial artery between 2006-2007.
• Midarm AVFs served as a secondary choice in 70% of cases and primary in 30%.
• Excellent survival was observed, with only one thrombosis and 14 functioning accesses after 6 months; four cases were lost due to patient death.

Impact:

• Midarm AVFs demonstrate excellent patency and survival, particularly in patients with diabetes and generalized vascular disease.
• This technique offers a valuable alternative to distal AVFs, potentially becoming the preferred choice for specific high-risk patient groups.
• The study suggests midarm AVFs are a crucial option, not just as an intermediate step but as a primary solution for challenging hemodialysis access needs.