title: Salvage of Early-Failing Radiocephalic Fistulae with Techniques that Minimize Venous Dissection.
abstract: Although radiocephalic fistulae are the preferred hemodialysis access, juxta-anastomotic stenosis is often responsible for early fistula failure. We hypothesized that wall ischemia from surgical manipulation leads to early juxta-anastomotic neointimal hyperplasia and failure of maturation and that minimal venous dissection will improve surgical salvage, increasing fistula maturation rates. For failing-to-mature radiocephalic fistulae that develop early juxta-anastomotic stenosis, we describe 3 variations to perform a new proximal anastomosis with a minimal dissection technique on the forearm cephalic vein: (1) side-to-side anastomosis, (2) radial artery deviation and reimplantation, or (3) radial artery deviation and loop reimplantation. Minimal dissection of the cephalic vein achieves fistula salvage without needing a more proximal site for access.
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sadaghianloo
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Elixène
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Khalid
authors.initials: K
authors.lastname: Rajhi
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Haudebourg
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Declemy
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France. Electronic address: hassen-khodja@chu-nice.fr.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
mesh_terms: D000714:Anastomosis, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D058426:Neointima; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation; D012092:Replantation; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*