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Updated: Jun 6, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Venae comitantes as a potential vascular resource to create native arteriovenous fistulae
Walter Morale1, Domenico Patanè, Concetta Incardona
1Division of Nephrology, Emergency Hospital "Cannizzaro", Catania, Italy. waltermorale@yahoo.it
Insights
Arteriovenous fistula (AVF) using venae comitantes offers a viable alternative for hemodialysis (HD) access when other options are unavailable. This method achieved a 62% technical and functional success rate in patients with chronic renal failure.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD).
- Alternative AVF strategies are needed when standard options are not feasible.
Purpose of the Study:
- To evaluate the efficacy of AVF creation using venae comitantes for hemodialysis access.
- To assess the outcomes and complications of this alternative AVF approach.
Main Methods:
- Retrospective analysis of 60 patients with chronic renal failure undergoing AVF creation using the deep venous circle.
- Focus on 48 patients with direct brachial artery-vena comitans anastomosis and long-term follow-up (mean 59 weeks).
Main Results:
- Immediate success (patency and thrill) was 88%; primary accessibility was 62%, reaching 71% after revisions.
- Complication rate was 10% over 80 weeks, with 62% overall technical and functional success for adequate HD.
- Cumulative patency was 71% at 80 weeks.
Conclusions:
- AVF creation utilizing venae comitantes is a suitable alternative for hemodialysis access.
- This technique can be beneficial in critical cases where conventional vascular access is not possible.
Purpose:
The arteriovenous fistula (AVF) represents the gold standard for hemodialysis (HD) vascular access. In some critical cases, use of the deep venous circle may represent an alternative approach and venae comitantes could be employed for this purpose.
Methods:
Sixty patients with chronic renal failure in which the deep venous circle was used to create an AVF were identified; of the 48 who had a direct anastomosis between the brachial artery and vena comitans, 42 had a long-term follow-up (mean follow-up 59 weeks), while six were lost to follow-up.
Results:
Immediate success (patency and palpable thrill) was achieved in 88% of cases (primary and early failure 12%). Primary accessibility rate was 62%, while 11 patients required a second surgical approach to make the vein accessible to needling. Secondary accessibility rate of 71% was due to surgical revisions. In the 80-week observation period, the complication rate was 10% with irreversible loss of the AVF in all these cases. Cumulative patency was 71% at the 80th week. Including all 42 patients, technical and functional success rate, defined as vein accessibility to needling and chance of an adequate HD treatment, was 62%.
Conclusions:
AVF employing venae comitantes may represent a suitable alternative in the absence of other vascular accesses for HD.
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