title: High brachial artery bifurcation: clinical considerations and practical implications for an arteriovenous access.
abstract: High brachial artery bifurcation (HiBAB) is not a rare occurrence. Recent data have emphasized that HiBAB can have major clinical implications including high failure rate and decreased functional patency of an arteriovenous (AV) fistula. In this retrospective study, we investigated the incidence of HiBAB. Patients with advanced chronic kidney disease and end-stage renal disease on chronic hemodialysis undergoing preoperative vascular mapping for the creation of an AV access were included in this analysis. Ultrasound examination was used to map the arteries of the upper extremities. Four hundred and eighty-one arms in 340 patients were examined (right arm = 181, left arm = 300). Sixty-nine of the 481 (12.3%) demonstrated HiBAB. The internal diameter of the radial and ulnar arteries measured at the elbow region was found to be 2.9 ± 0.8 and 3.6 ± 1.0 mm, respectively (p = 0.0001). There were no statistically significant differences in terms of race, gender, and right versus left arms regarding the incidence of HiBAB. As HiBAB can be present in a significant number of patients and have an impact on the AV access, its presence should be evaluated during vascular mapping prior to an AV access creation.
authors.affiliation: Interventional Nephrology, Denver Nephrology, Denver, Colorado, USA.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Kian
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Shapiro
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
authors.forename: Rao Ali Hashim
authors.initials: RA
authors.lastname: Khan
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Leonel
authors.initials: L
authors.lastname: Garcia
authors.forename: Nadia
authors.initials: N
authors.lastname: Eid
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
authors.forename: Adam
authors.initials: A
authors.lastname: Aldahan
authors.forename: Gerald
authors.initials: G
authors.lastname: Beathard
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001916:Brachial Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011300:Preoperative Care / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D054079:Vascular Malformations / Q000000981:diagnostic imaging / Q000453:epidemiology; D014654:Vascular Patency