Native Radiocephalic Arteriovenous Fistula Creation in Al – Hussein Teaching Hospital ( 2013-2019 ): Review of 50 cases

  • Ali Mohsin Obaid Al-Hussein Teaching Hospital / Thi-Qar Governorate / Iraq
  • Ahmed Abdulameer Daffar Medical College / Thi-Qar University / Iraq
  • Jalal Jaafar Abdulhussein Nasiriyah Cardiac Centre / Thi-Qar Governorate / Iraq

Abstract

Objective : To present the advantages of native radio-cephalic AVF creation over native brachio-cephalic AVF creation in patients with chronic renal failure and on regular hemo – dialysis. Patients : This is a retrospective study of 50 patients for whom native radio-cephalic AVF was created  in the upper limb under local anesthesia over a period of about seven years ( from 1st of March 2013 till 1st of February 2019 ). Methods: The case sheets of relevant patients for whom an AVF was created  were reviewed to collect information like patient's sex, age,  site of AVF,  type of anastomosis, etc… Results : Native radio-cephalic AVF creation was offered for different age groups and for both sexes. Side to side anastomosis was carried out for most patients and the preferred site was just above the wrist joint on the lateral aspect of forearm between the radial artery and a nearby superficial vein which was mostly the cephalic vein or one of it's tributaries. The time of first cannulation after AVF creation was variable depending on several factors. Different complications but no mortality  had been recorded perioperatively.   Conclusions : Native radio-cephalic AVF creation is always preferred over native brachio-cephalic AVF creation and every effort was made to search for a suitable distally located superficial vein for the purpose of AVF creation. The region just above the wrist joint on the lateral aspect of forearm was a suitable site for patients with CKD and those with comorbidities because the proximal locations of AVF creation are associated with more complications than the distal ones. Side to side anastomosis for AVF creation was the procedure of choice and the priority was for the non dominant upper limb if possible.

References

NKF-K/DOQI Clinical practice guidelines for vascular access: Update 2000. Am J KidneyDis,37:S137-S181,2001.

Chesser AM, Baker LR: Temporary vascular access for first dialysis is common, undesirable and usually avoidable. Clin Nephrol 51:228–232, 1999.

Bander SJ, Schwab SJ: Central venous angioaccess for hemodialysis and its complications. Semin Dial 5:121–128, 1992.

Schwab SJ, Quarles LD, Middleton JP, et al: Hemodialysis-associated subclavian vein stenosis. Kidney Int 33:1156–1159, 1988.

Barrett N, Spencer S, McIvor J, Brown EA: Subclavian stenosis: A major complication of subclavian dialysis catheters. Nephrol Dial Transplant 3:423–425, 1988.

Spinowitz BS, Galler M, Golden RA, et al: Subclavian vein stenosis as a complication of subclavian catheterization for hemodialysis. Arch Intern Med 147:305–307,1987.

Schillinger F, Schillinger D, Montagnac R, Milcent T: Post catheterisation vein stenosis in haemodialysis: Comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 6:722–724, 1991.

Cimochowski GE, Worley E, Rutherford WE, et al: Superiority of the internal jugular over the subclavian access for temporary hemodialysis. Nephron 54:154–161, 1990.

Moss AH, Mclaughlin MM, Lempert KD, Holley JL: Use of a silicone catheter with a Dacron cuff for dialysis short-term vascular access. Am J Kidney Dis 12:492–498,1988.

DeMeester J, Vanholder R, Ringole S: Factors affecting catheter and technique survival in permanent silicone single lumen dialysis catheters [abstract]. J Am Soc Nephrol,3:361A,1992.

Schwab SJ, Buller GL, McCann RL, et al: Prospective evaluation of a Dacron cuffed hemodialysis catheter for prolonged use. Am J Kidney Dis 11:166–169, 1988.

Suchoki P, Conlon P, Knelson M, et al: Silastic cuffed catheters for hemodialysis vascular access: Thrombolytic and mechanical correction of HD catheters malfunction. Am J Kidney Dis 28:379–386, 1996.

Trerotola SO: Interventional radiology in central venous stenosis and occlusion. SeminIntervRadiol,11:291–304,1994.

Palder SB, Kirkman RL, Whittemore AD, et al: Vascular access for hemodialysis: Patency rates and results of revision. Ann Surg 202:235–239, 1985.

Raju S: PTFE grafts for hemodialysis access: Techniques for insertion and management of complications. Ann Surg 206:666–673, 1987.

Middleton WD, Picus DD, Marx MV, Melson GL: Color Doppler sonography of hemodialysis vascular access: Comparison with angiography. AJR Am J Roentgenol 152:633–639,1989.

Tordoir JHM, Hoeneveld H, Eikelboom BC, Kitslaar PJEHM: The correlation between clinical and duplex ultrasound parameters and the development of complications in arterio-venous fistulae for hemodialysis. Eur J Vasc Surg 4:179–184, 1990.

Tordoir JHM, De Bruin HG, Hoeneveld H, et al: Duplex ultrasound scanning in the assessment of arteriovenous fistulas created for hemodialysis access: Comparison with digital subtraction angiography. J Vasc Surg 10:122–128, 1989.

Glanz S, Bashist B, Gordon DH, et al: Axillary and subclavian vein stenosis: Percutaneous angioplasty. Radiology 168:371–373, 1988.

Brescia M, Cimino J, Appel K, et al: Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 275:1089–1092, 1966.

Rutherford R (ed): Vascular Surgery, 5th ed. Philadelphia, WB Saunders, 2000.

Miller PE, Tolwani A, Luscy CP, et al: Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 56:275–280, 1999.

Palder SB, Kirkman RL, Whittemore AD, et al: Vascular access for hemodialysis: Patency rates and results of revision. Ann Surg 202:235–239, 1985.

Kinnaert P, Vereerstraeten P, Toussaint C, Van Geertruyden J: Nine years’ experience with internal arteriovenous fistulas for hemodialysis: Study of some factors influencing results. Br J Surg 64:242–246, 1977.

Kherlakian GM, Roedersheimer LR, Arbaugh JJ, et al: Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis. Am J Surg 152:238–243, 1986.

Silva MB, Hobson RW, Pappas PJ, et al: Vein transposition in the forearm for autogenous hemodialysis access. J Vasc Surg 26:981–988, 1997.

Dagher F, Gelber R, Ramos E, et al: The use of basilic vein and brachial artery as an A-V fistula for long term hemodialysis. J Surg Res 20:373–376, 1976.

Illig KA, Orloff M, Lyden SP, et al: Transposed saphenous vein arteriovenous fistula revisited: New technology for an old idea. Cardiovasc Surg 10:212–215, 2002.

NKF-KDOQI. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S248–S272. [PubMed]

Whittaker L, Bakran A. Prevention better than cure. Avoiding steal syndrome with proximal radial or ulnar arteriovenous fistulae. J Vasc Access 2011;12:318-20.

Yuksekdag S, Topcu A, Unal E (2019) A Retrospective Analysis of rteriovenous Fistulas as Hemodialysis Access Surgery in the Perspective of KDOQI (Kidney Disease Outcomes Quality Initiative) Guidelines. Int J Transplant Res Med 5:038. doi.org/10.23937/2572- 4045.1510038

O'Banion LA, Van Buren D, Davis JW. Radiocephalic fistulas for hemodialysis: A comparison of techniques. Am Surg. 2015;81:341–4. [PubMed]

Pramila DR, Biradar S. A study of arteriovenous fistula failure in haemodialysis patients. Sch J Appl Med Sci. 2014;2:336–9.

Gonzalez E, Kashuk JL, Moore EE, Linas S, Sauaia A. Two-stage brachial-basilic transposition fistula provides superior patency rates for dialysis access in a safety-net population. Surgery. 2010;148:687–93. [PMC free article] [PubMed]

Checherita IA, TuTa LA, David C, Peride I, Niculae A, Geavlete BF, et al. An overview of permanent vascular access in hemodialyzed patients. Rom J Morphol Embryol. 2015;56:27–31. [PubMed]

Published
2019-08-02
Section
Articles