Creating reverse flow arteriovenous fistulas with a forearm cannulation target

Area of Science:

• Vascular Surgery
• Nephrology
• Dialysis Access

Background:

• Forearm arteriovenous fistulas (AVFs) are preferred for hemodialysis access, preserving proximal sites.
• When wrist AVFs are not feasible, alternative forearm access like grafts or complex procedures are often needed.
• Retrograde flow forearm AVFs (RF-AVFs) offer an autogenous option using mid-forearm veins for outflow through collaterals.

Purpose of the Study:

• To report the technique and outcomes of establishing retrograde flow forearm AVFs (RF-AVFs).
• To evaluate RF-AVFs as a viable forearm cannulation target when distal options are inadequate.
• To assess the feasibility of RF-AVFs in patients requiring forearm vascular access.

Main Methods:

• Retrospective review of a vascular access database over 11 years.
• Inclusion criteria: RF-AVF as the sole forearm cannulation target.
• Vessel mapping included physical examination and ultrasound; data on patient demographics, inflow source, and outcomes were analyzed.

Main Results:

• 48 patients (median age 62 years) underwent RF-AVF creation; 44% female, 63% diabetic.
• Primary and cumulative patency rates were 62% and 91% at 12 months, and 46% and 85% at 24 months.
• Nine AVFs (19%) failed; one was ligated due to edema. Mean follow-up was 23.5 months.

Conclusions:

• Retrograde flow forearm AVFs are a successful autogenous access option for selected patients.
• This technique avoids complex procedures and preserves upper arm access sites.
• Proximal radial artery inflow is recommended for establishing RF-AVFs.