Superficialization of the radial artery--an alternative secondary vascular access.
OBJECTIVE
The standard approach in patients with a clotted arteriovenous fistula (AVF) on the forearm is the creation of another vascular access on the arm using the patient's own vessels or a prosthetic graft. Here we propose another option as secondary angioaccess for chronic hemodialysis (HD): superficialization of the radial artery.


METHODS
Indications for the procedure were 1) long-standing forearm AVF that has irreversibly clotted and/or central vein stenosis resistant to angioplasty; 2) patients who have no other prospect for forearm or even brachial AVF. The procedure was undertaken in 7 chronic HD patients dialyzed by forearm AVF for 27±26 months.


RESULTS
In one case the superficialization was abandoned intra-operatively due to small diameter of the artery (<4 mm). Five of 6 elevated arteries were patent and the follow-up period ranges from 11 to 15 (median 12) months. In 1 male patient with prothrombin G20210A mutation the artery clotted after 13 months of usage.


CONCLUSIONS
Superficialized radial artery was successfully used for hemodialysis over one year. The only prerequisite for safe repeated puncture is a patent and enlarged radial artery. Due to avoidance of arteriovenous shunt this access type may be particularly suitable for patients with cardiac failure.
Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland.
Wacław
W
Weyde
Mariusz
M
Kusztal
Tomasz
T
Gołębiowski
Krzysztof
K
Letachowicz
Waldemar
W
Letachowicz
Ewa
E
Wątorek
Katarzyna
K
Madziarska
Magdalena
M
Krajewska
Przemysław
P
Szyber
Dariusz
D
Janczak
Marian
M
Klinger
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011677:Punctures; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency