Side-to-side arteriovenous fistula at the elbow with perforating vein ligation.
OBJECTIVE
We postulated that ligation of a consistent perforating venous branch at the elbow would improve distention and flow in the superficial veins about the elbow. This would also lesson the likelihood of arterial steal enabling a favorable outcome following a brachial artery medial antecubital or cephalic vein arterio-venous fistula (AVF).


METHODS
Pressure measurements were made from the radial artery after side-to-side brachial artery antecubital or cephalic vein AVF in 20 patients. Clamping of the perforating vein increased radial artery pressure significantly indicating that a considerable amount of flow from the side-to-side AVF was diverted into the deep system and away from the accessible superficial veins. Encouraged by this finding, we studied the outcome of brachial cephalic or brachial antecubital AVF with ligation of the deep branch in 134 patients who were not candidates for radio-cephalic AVF. The end point of the study was successful hemodialysis using the fistula.


RESULTS
Of the 134 patients treated, 24 died, and 11 were lost to follow-up and were censored from analysis of fistula performance at that time point. The primary fistula success rate was 89.7% +/- 2.66% and 83.7% +/- 3.5% at 1 and 2 years by life table analysis. No patient developed significant arterial steal or venous hypertension.


CONCLUSIONS
We recommend this simple one-stage procedure for patients requiring hemodialysis whose cephalic vein at the wrist is unsuitable.
Moini
Majid
M
Division of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Williams
G Melville
GM
Pourabbasi
Mohammad Sadegh
MS
Rasouli
Mohammad Reza
MR
Tarighi
Payam
P
Mardanloo
Armita
A
Rayatzadeh
Hussein
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D016121:Brachiocephalic Veins / Q000503:physiopathology / Q000601:surgery*; D004550:Elbow / Q000098:blood supply*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014690:Venous Pressure