Salvage of Early-Failing Radiocephalic Fistulae with Techniques that Minimize Venous Dissection

Ann Vasc Surg. 2015 Oct;29(7):1475-9. doi: 10.1016/j.avsg.2015.04.075. Epub 2015 Jun 26.

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.

MeSH terms

  • Anastomosis, Surgical
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Forearm / blood supply*
  • Humans
  • Neointima
  • Radial Artery / diagnostic imaging
  • Radial Artery / physiopathology
  • Radial Artery / surgery*
  • Renal Dialysis*
  • Reoperation
  • Replantation
  • Salvage Therapy*
  • Time Factors
  • Treatment Failure
  • Ultrasonography, Doppler, Duplex
  • Vascular Patency
  • Veins / diagnostic imaging
  • Veins / physiopathology
  • Veins / surgery*