Use of short prosthesis segments for brachiocephalic arteriovenous fistulas in elderly hemodialysis population.
BACKGROUND
The autogenous brachiocephalic fistula is a recognized secondary access for hemodialysis. However, veins in the antecubital fossa are often damaged, due to repeated venipunctures and subsequent scarring. Sometimes their anatomy does not enable successful arteriovenous fistula creation. In cases when the proximal part of the cephalic vein seemed patent, during ultrasound Doppler examination, we decided to use a short segment of 6 mm polytetrafluoroethylene graft to connect the vein with the brachial artery. We report our series of this procedure.


METHODS
Over an 8-year period, 34 patients underwent such an operation. Grafts were anastomosed either to the end of the cephalic vein or to the side. The decision was made based on the vein condition: small-caliber veins were considered better for the end-to-side anastomosis. All procedures were performed under local anesthesia, and were well tolerated.


RESULTS
Thirty-three fistulas were successfully cannulated at 2-8 weeks after the operation. Fistula patency rates were 84%, 73% and 55% at 12, 24 and 36 months. Comparison of two anastomosis types showed differences, 50% and 62.8% at 36 months, yet without statistical significance (p = 0.27, log-rank test). Fistula patency was not influenced by patient's age, sex or comorbidities.


CONCLUSIONS
The described procedure provides satisfactory cumulative patency with an acceptable complication rate. It can enhance the number of cephalic veins used with its main advantages of simple surgical technique and low perioperative morbidity.
Department of Vascular Surgery and Transplantology, Medical University of Bialystok, Poland.
Jerzy
J
Głowiński
Department of Nephrology and Transplantology, Medical University of Bialystok, Poland.
Jolanta
J
Małyszko
Department of Nephrology and Transplantology, Medical University of Bialystok, Poland.
Irena
I
Głowińska
Department of Nephrology and Transplantology, Medical University of Bialystok, Poland.
Michał
M
Myśliwiec
hemodialysis; native fistula; vascular access