title: Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency.
abstract: Introduction Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous 'real estate' but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. Methods A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. Results Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). Conclusion Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity.
authors.affiliation: Department of Transplant Surgery, Central Manchester University NHS Foundation Trust , UK.|Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester , UK.
authors.forename: David
authors.initials: D
authors.lastname: van Dellen
authors.affiliation: Department of Transplant Surgery, Central Manchester University NHS Foundation Trust , UK.|Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester , UK.
authors.forename: Muneer
authors.initials: M
authors.lastname: Junejo
authors.affiliation: Department of Transplant Surgery, Central Manchester University NHS Foundation Trust , UK.|Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester , UK.
authors.forename: Hussein
authors.initials: H
authors.lastname: Khambalia
authors.affiliation: Department of Transplant Surgery, Central Manchester University NHS Foundation Trust , UK.|Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester , UK.
authors.forename: Babatunde
authors.initials: B
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery*; D016121:Brachiocephalic Veins / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000941:ethics / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014654:Vascular Patency / Q000502:physiology*; D014656:Vascular Surgical Procedures / Q000941:ethics / Q000379:methods*
keywords: Arteriovenous fistula; Minimally invasive; Patency; vascular access