title: Interrupting connection of superficial and deep veins of the upper extremity at the elbow for creation of hemodialysis arteriovenous fistulas.
abstract: We hypothesized that interrupting the connection between superficial and deep veins of the upper extremity at the elbow for creation of hemodialysis arteriovenous fistulas (AVFs), in addition to adequate dilation of the elbow veins, will reduce the risk of steal syndrome and venous hypertension. In this prospective study over a period of one year, patients who were candidates for creation of elbow AVFs based on Doppler ultrasound findings and physical examination, were enrolled into the study. For creation of AVFs, based on the anatomy of the vessels, side-to-side or end-to-side anastomosis between the brachial artery and either cephalic or median antecubital or basilic veins was performed. In some cases, Gracz AVF was created. For interrupting the connection between superficial and deep veins, the perforating vein was either ligated or used for anastomosis. The patients were then followed-up regarding patency rate of the AVF and complications. AVFs were created in 50 patients and the duration of follow-up varied from one to eight months. About 56% (n = 28) of the patients had history of failed AVF or arteriovenous graft and 48% (n = 24) of them had history of insertion of a dual-lumen catheter for hemodialysis. Neuromuscular problem (n=1) and infection (n=1) were the observed complications. None of the patients developed steal syndrome or venous hypertension. At the end of the study, 47 AVFs (94%) were patent and adequate. Our study suggests that interrupting the connection between the superficial and deep venous systems of the upper extremity can reduce the risk of development of steal syndrome and venous hypertension despite side-to-side anastomosis. These techniques provided acceptable patency rate for elbow AVFs.
authors.affiliation: Division of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. moinim@sina.tums.ac.ir
authors.forename: Majid
authors.initials: M
authors.lastname: Moini
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.forename: Shahram
authors.initials: S
authors.lastname: Salehirad
authors.forename: Maryam
authors.initials: M
authors.lastname: Nazarinia
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001916:Brachial Artery / Q000601:surgery; D004550:Elbow / Q000098:blood supply*; D005260:Female; D006801:Humans; D007492:Iran; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014690:Venous Pressure