title: Percutaneous valvulotomy as an alternative to transposition of a brachiocephalic fistula.
abstract: Transposition of a deep (9-12 mm) autogenous brachiocephalic vein fistula was required for adequate hemodialysis access in a morbidly obese patient. The patient was a poor candidate for surgical transposition of the upper-arm cephalic vein. As an alternative, retrograde fistula flow was established percutaneously through a 6-F sheath in the forearm cephalic vein with the over-the-wire LeMaitre valvulotome. The retrograde flow in the forearm added 7 cm of superficial vein 6.2-9 mm in diameter with a flow rate of 940-2,868 mL/min, eliminating the need for surgical transposition. The percutaneous technique and required anatomy are described.
authors.affiliation: Richmond Vascular Center, 173 Wadsworth Dr., North Chesterfield, VA 23236. Electronic address: jhull@richmondvascularcenter.com.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Hull
authors.affiliation: Richmond Vascular Center, 173 Wadsworth Dr., North Chesterfield, VA 23236.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Makhoul
authors.affiliation: Richmond Vascular Center, 173 Wadsworth Dr., North Chesterfield, VA 23236.
authors.forename: James F
authors.initials: JF
authors.lastname: Snyder
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012039:Regional Blood Flow; D006435:Renal Dialysis; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D055422:Venous Valves / Q000000981:diagnostic imaging / Q000503:physiopathology*