Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease

Abstract

Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations
 Bangladesh Heart Journal 2018; 33(2) : 134-137

Combined interscalene and supraclavicular brachial plexus block using ultrasound guidance versus general anaesthesia for brachioaxillary graft in patients with chronic renal failure

“…They concluded that the combined block provides good anaesthesia for the entire right upper limb, and explained that SCB is a reliable technique giving anaesthesia for the distal arm and ISB increased the remaining quality of the motor and sensory blockade. 16 In our study, we observed significant decrease in NRS in RA group during the 24 hour postoperative period that compares with Gebhard et al who reported the advantage of postoperative analgesia after regional anaesthesia. 17 The significant reduction in frequency of analgesia requirement and the longer duration of the first need of analgesia in RA group could be explained by excellent analgesia of both blocks.…”

“…20 To our knowledge, only few studies have discussed combined SCB and ISBusage. 1,16,20 Our study is the first to describe this combined block in patients with CRF.…”

“…Anaesthesia for those patients is a challenge and needs further skills. 13 General anaesthesia may decrease renal blood flow up to 50% leading to reduced nephrotoxic drugs excretion. 14 Despite BPB providing a promising alternative to other anaesthetic techniques due to less exposure to the various anaesthetic drugs, vasodilator effect, early mobility and excellent postoperative analgesia 15 , there is no evidence for the best approaches of BPB for brachioaxillary graft surgery.…”