title: No-touch technique for radiocephalic arteriovenous fistula--surgical technique and preliminary results.
abstract: OBJECTIVE
  The radiocephalic arteriovenous fistula (RC-AVF) has significant failure rates due to occlusions and failure to mature. The size and quality of the veins are considerable limiting factors for the procedure. The aim of this pilot study was to describe the No-Touch technique (NTT) to create RC-AVF and present the results up to 1 year of follow-up.
  
  
  METHODS
  Thirty-one consecutive patients who were referred for surgery for a RC-AVF were included (17 men, mean age 63 years, range 35-84) and operated by NTT where the vein and artery were dissected with a tissue cushion around it. Twenty-two patients had small veins or arteries (≤2 mm), 12 patients had a small cephalic vein (≤2 mm), and the mean distal cephalic vein diameter was 2.4 mm (range 1.0-4.1 mm).
  
  
  RESULTS
  Technical surgical success and immediate patency were obtained in all patients. Clinical success was achieved in 23 of the 27 (85%) patients who required hemodialysis. The proportion of primary patency at 30 days and 6 months was 84% and 64%, respectively. Secondary patency at 30 days and 6 months was 97% and 83%, respectively. At 1-year follow-up, primary patency was 54% and secondary patency was 80%. There was no major difference in patency due to preoperative vein diameter.
  
  
  CONCLUSIONS
  The results of this study indicate that NTT can be used for primary radio-cephalic fistula surgery with very good results. This method offers the potential to create a RC-AVF in patients who are not usually considered appropriate for a distal arm fistula due to a small cephalic vein.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro - Sweden.
authors.forename: Tal M
authors.initials: TM
authors.lastname: Hörer
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro - Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Skoog
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro - Sweden.
authors.forename: Robin
authors.initials: R
authors.lastname: Quell
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro - Sweden.
authors.forename: Kristofer F
authors.initials: KF
authors.lastname: Nilsson
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro - Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Larzon
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro - Sweden.
authors.forename: Domingos R
authors.initials: DR
authors.lastname: Souza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004210:Dissection; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency