Venae comitantes as a potential vascular resource to create native arteriovenous fistulae.
OBJECTIVE
The arteriovenous fistula (AVF) represents the gold standard for hemodialysis (HD) vascular access. In some critical cases, use of the deep venous circle may represent an alternative approach and venae comitantes could be employed for this purpose.


METHODS
Sixty patients with chronic renal failure in which the deep venous circle was used to create an AVF were identified; of the 48 who had a direct anastomosis between the brachial artery and vena comitans, 42 had a long-term follow-up (mean follow-up 59 weeks), while six were lost to follow-up.


RESULTS
Immediate success (patency and palpable thrill) was achieved in 88% of cases (primary and early failure 12%). Primary accessibility rate was 62%, while 11 patients required a second surgical approach to make the vein accessible to needling. Secondary accessibility rate of 71% was due to surgical revisions. In the 80-week observation period, the complication rate was 10% with irreversible loss of the AVF in all these cases. Cumulative patency was 71% at the 80th week. Including all 42 patients, technical and functional success rate, defined as vein accessibility to needling and chance of an adequate HD treatment, was 62%.


CONCLUSIONS
AVF employing venae comitantes may represent a suitable alternative in the absence of other vascular accesses for HD.
Division of Nephrology, Emergency Hospital "Cannizzaro", Catania, Italy. waltermorale@yahoo.it
Walter
W
Morale
Domenico
D
Patanè
Concetta
C
Incardona
Giuseppe
G
Seminara
Martina
M
Messina
Pierantonio
P
Malfa
Giuseppe
G
L'Anfusa
Giuseppe
G
D'Arrigo
Demetrio
D
Spanti
Maria Luisa
ML
Mandalà
Domenico
D
Di Landro
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001916:Brachial Artery / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000601:surgery