The brachio-brachial arteriovenous fistula: a new method in patients without a superficial venous system in the upper limb.
OBJECTIVE
This study aimed to report our experience in the creation of brachio-brachial arteriovenous fistulas (AVFs) in patients without adequate superficial venous circulation at the upper limb.


METHODS
A retrospective study of 33 patients, operated on between 2004-2005, in whom we created a brachio-brachial fistula between the brachial artery and the brachial vein. After dissection and adequate mobilization, the brachial vein was anastomized to the brachial artery in an end-to-side fashion. After the maturation period (1 month) the brachial vein was transposed into the subcutaneous tissue.


RESULTS
Thirty-three patients underwent 33 brachio-brachial fistula constructions. Primary patency was achieved in all patients. After 1 month, 27 fistulas (81.8%) were functional. Six patients developed fistula occlusion. The 27 remaining patients had subsequently good fistulas for hemodialysis (HD) afterwards. Discrete edema of the forearm was noted in 12 patients (36%); in one of these patients the edema was extended to the entire arm. No other complications were noted. A follow-up study, extended from 3-26 months (mean 14 +/- 6.6 months), was performed. The overall patency rate of the brachio-brachial fistula at the end of the follow-up was 85.2%.


CONCLUSIONS
The brachio-brachial fistula can represent a viable choice in patients with an inadequate superficial venous system in the upper limb.
Dorobantu
L F
LF
University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania. ludorobantu@yahoo.com
Stiru
O
O
Iliescu
V A
VA
Novelli
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000601:surgery*