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Background: The arteriovenous fistula is the modality of choice for long-term haemodialysis access. We describe the feasibility of routinely fashioning a brachiocephalic fistula utilising a 3 mm long arteriotomy in an attempt to reduce the incidence of symptomatic steal syndrome yet while maintaining satisfactory clinical outcomes. Methods: All patients who underwent brachiocephalic fistula formation using a routine 3 mm long arteriotomy within Hammersmith Hospital between January 2017 and March 2018 were included. Primary outcomes included primary failure, failure of maturation, secondary patency and steal syndrome. Results: Sixty-eight brachiocephalic arteriovenous fistula were fashioned utilising a 3 mm long arteriotomy during the study period. Mean age was 60.5 years with 59% having a history of diabetes mellitus. Mean followup was 368 days. Primary failure occurred in 10 (14.7%) patients. Cannulation was achieved in 67.3% of remaining fistula within 3-months, rising to 87.3% by 6-months. Primary patency at 6 and 12 months was 76% and 69%, respectively. Secondary patency at 6 and 12 months was 94% and 91%, respectively. Dialysis access steal syndrome was clinically apparent in three (4.4%) patients with all cases being managed conservatively. Conclusion: A 3 mm long arteriotomy may be routinely utilised for brachiocephalic fistula creation in an attempt to limit the incidence of steal syndrome yet while maintaining clinical patency outcomes.

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Introduction Groove pancreatitis (GP) is a form of chronic segmental pancreatitis. Due to increased awareness of the condition, a greater number of cases have been reported in recent years. Clinical symptoms are heterogeneous, with abdominal pain and gastric outlet obstruction considered the most common, and can mimic pancreatic adenocarcinoma. Most of the published literature is represented by small series. Aim of the study is to describe our experience in the management of this condition. Methods From January 2005 to December 2011, 47 patients with GP were treated in our Unit. 33 males (M:F¼2.3:1); mean age was 50 (31e84), average number of hospital admissions was 4 (0e20), mean hospital stay was 10 days (1e82). Eight patients needed HDU/ICU support. Aetiology was alcohol in 41 (87%) and 13 were abstinent for more than 6 months at last follow-up. Amylase was elevated (3xN) on admission in 22. The most common feature was abdominal pain (n¼40, 85%) and 50% (n¼20) required daily use of opioids. Gastric outlet obstruction (n¼7), jaundice (n¼11) and acute renal failure (n¼5) were less frequent. Exocrine insufficiency was present in 23 (49%). 13 had a dilated pancreatic duct (>5 mm) and 6 developed portal hypertension. Median follow-up was 34 months. Results There were five deaths, one due to GP. 29 patients were treated conservatively; 11 required enteral feeding. 4 had ERCP and biliary stenting, two of which subsequently underwent biliary reconstruction. One patient had a pancreatic stent and then a Berne's procedure. Endoscopic drainage for pseudocyst (n¼2), cholecystectomy (n¼6) for sludge/stones, gastric bypass (n¼3), Puestow procedure (n¼1), Whipple's operation (n¼4, two of which later required thoracoscopic splanchnicectomydTS), TS (n¼3), celiac plexus block (n¼2) were the other interventions. Overall 28 (66%) patients are well with no or occasional use of analgesia, six patients still experience recurrent hospital admissions and 8 require regular use of analgesia but with improved symptoms. Conclusion The majority of GP is caused by alcohol excess. GP can be effectively treated conservatively and pain (the most common symptom) managed with simple analgesia. Despite good support the majority remain addicted to alcohol. Radical surgery should be reserved for complex cases, as it is not always effective for pain relief, and when there is a diagnostic dilemma.