Distal forearm perforating vein for native arteriovenous fistula

Two major groups of perforators connecting, through the deep fascia, the superficial veins (under the superficial fascia) to the radial and ulnar venae comitantes (under the deep fascia). The well-known proximal perforating vein is in the antecubital fossa. In the distal part of the forearm numerous perforators were found, concentrated on the radial side. The purpose of this study is to describe utilization of distal perforating vein (DPV) as an outflow for native arteriovenous fistula in distal part of the forearm.

Sixteen patients with chronic kidney disease in stages G4 and G5, aged 56 ± 14.7 years, who underwent AVF utilizing DPV (DPV-AVF), were qualified for the study. All patients underwent vascular mapping using ultrasound to identify DPV. AVF function was assessed after 24 h and during 6-weeks follow-up. Primary, assisted, and secondary fistula survival were evaluated using a life table.

All AVFs were patent after discharging. No short time complications were observed. The mean diameter increase of the radial artery, brachial artery, and vein in the antecubital fossa 24 h after surgery was 1 ± 0.8, 0.7 ± 0.4, 1 ± 1.3 mm, respectively. The mean fistula flow rate was 513.7 ± 184.5 ml/min 24 h post-surgery. The first cannulation was uneventful in 29 days post-surgery in 8 (50%) patients. Primary patency rates at 1, 3, and 6 months were 87.5%, 62.5%, and 43.8%, respectively.

All 16 fistulas demonstrated adequate functionality, similar to standard radiocephalic fistula (RCAVF). Due to the proximity of the radial artery and the DPV, the wound was much smaller than RCAVF. Using the DPV as a drainage vein preserves other options for creating an AVF in the proximal forearm.