title: Radial artery-perforating vein fistula for hemodialysis.
abstract: BACKGROUND
  The proximal forearm antecubital fistula described by Gracz is a valuable option for autogenous vascular access for hemodialysis in patients with destroyed forearm veins or advanced arteriosclerotic and calcified radial arteries. Results obtained with a variant of the Gracz fistula are presented.
  
  
  METHODS
  Patients with forearm vein destruction or failed distal radiocephalic fistulas were selected to have a variant of the Gracz fistula created and were followed up for 36 months. In each patient, the radial artery was anastomosed side to end or end to end to the perforating vein. Additionally, in some patients, the median cephalic or basilic vein was relocated subcutaneously to increase the accessibility of veins for puncture.
  
  
  METHODS
  Native arteriovenous fistulas (AVFs) in the cubital region using a perforating vein were created in 77 patients (34 women, 43 men) referred to the Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland, from 1992 to 2006.
  
  
  METHODS
  Percentages of successful fistula creation and primary patency rates, defined from fistula placement to any maintaining intervention, and cumulative patency, defined from placement to fistula abandonment, were assessed.
  
  
  RESULTS
  AVF creation was successful in 56 patients (73%). Primary patency rates during the follow-up period were 47% after 1 year, 43% after 2 years, and 39% after 3 years. Cumulative patency rates were 67% after 1 year, 56% after 2 years, and 53% after 3 years.
  
  
  CONCLUSIONS
  These results reflect performance of a single center and thus may not be generalizable to surgeons less experienced in this technique.
  
  
  CONCLUSIONS
  Radial artery-perforating vein fistulas have an acceptable survival rate and do not produce circulatory complications. This method may be applicable for AVF creation in patients with forearm vein destruction/abnormalities and as a rescue procedure for an old clotted fistula after kidney transplant failure.
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. klinef@am.centrum.pl
authors.forename: Waclaw
authors.initials: W
authors.lastname: Weyde
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kusztal
authors.forename: Magdalena
authors.initials: M
authors.lastname: Krajewska
authors.forename: Waldemar
authors.initials: W
authors.lastname: Letachowicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Watorek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Porazko
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Banasik
authors.forename: Dariusz
authors.initials: D
authors.lastname: Janczak
authors.forename: Jerzy
authors.initials: J
authors.lastname: Garcarek
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Madziarska
authors.forename: Ewa
authors.initials: E
authors.lastname: Trafidlo
authors.forename: Renata
authors.initials: R
authors.lastname: Klak
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D006435:Renal Dialysis; D012189:Retrospective Studies; D014654:Vascular Patency