Distal forearm perforating vein for native arteriovenous fistula

Area of Science:

• Vascular Surgery
• Nephrology
• Medical Devices

Background:

• Perforating veins connect superficial and deep venous systems.
• Distal forearm perforators, particularly on the radial side, are numerous.
• The distal perforating vein (DPV) can serve as an outflow vessel for arteriovenous fistulas (AVFs).

Purpose of the Study:

• To describe the utilization of the distal perforating vein (DPV) as an outflow for native arteriovenous fistula (AVF) in the distal forearm.
• To evaluate the safety and efficacy of DPV-AVF in patients with advanced chronic kidney disease.

Main Methods:

• Sixteen patients (stages G4/G5 CKD) underwent DPV-AVF creation.
• Vascular mapping with ultrasound identified the DPV.
• AVF function, patency, and complications were assessed post-surgery and during a 6-week follow-up.

Main Results:

• All 16 DPV-AVFs were patent post-discharge with no short-term complications.
• Mean fistula flow rate was 513.7 ml/min 24 hours post-surgery.
• Primary patency rates at 1, 3, and 6 months were 87.5%, 62.5%, and 43.8%, respectively.

Conclusions:

• DPV-AVF demonstrated adequate functionality comparable to standard radiocephalic AVF (RCAVF).
• The DPV-AVF technique resulted in smaller surgical wounds due to radial artery proximity.
• Utilizing the DPV preserves proximal forearm options for future AVF creation.