Outcomes of Brachiocephalic Fistulas, Transposed Brachiobasilic Fistulas, and Upper Arm Grafts

Maya, Ivan D.; O’Neal, Jeremy C.; Young, Carlton J.; Barker-Finkel, Jill; Allon, Michael

doi:10.2215/cjn.02910608

Cited by 109 publications

(106 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The secondary patency rate is lower than in other published series 15,16 and may reflect the co-morbid population with a high prevalence of diabetes and peripheral vascular disease (known factors associated with AVF failure). 17,18 Interestingly, nearly one-third of all BBF created were not used for HD.…”

Section: Utilization Of Avfcontrasting

confidence: 58%

Brachiobasilic fistulae: an upper limb autologous option for everyone?

et al. 2016

View full text Add to dashboard Cite

Purpose Autologous arteriovenous fistulae (AVF) are the vascular access option of choice. However, Brachiobasilic fistula (BBF) are complex procedures with variable outcomes reported in the literature. Our aim was to evaluate outcomes and morbidity associated with BBF in our population. Methods Retrospective analysis of prospectively collected data was undertaken for all 51 BBF created in our institution between January 2010 and March 2013. These were compared to an age and sex-matched group of brachiocephalic fistula (BCF) created over a similar time period. Demographic, operative and outcome data was collected for all patients. The primary end points were primary functional patency, primary-assisted patency and secondary patency at 3, 6 and 12 months. Continuous data was compared using Student's t-test and categorical data using chisquared test (p50.05 is significant). Results Mean patient age was 57 years (range: 21-82). About 45% were male. About 73% of patients were already on hemodialysis (HD) at the time of BBF creation. BBF was the secondary or tertiary access procedure in 60.8% of patients (n ¼ 31). BBF were associated with significant operative burden with 82% of patients requiring a general anaesthetic and median hospital admission of 2 days (range: 1-4). About 75% had a single-stage procedure. About 23.5% (n ¼ 12) required operative revision (superficialization or anastomotic revision for stenosis). Patients with BBF spent an additional 3.45 days/year in hospital as a result of access related complications compared to 0.56 days/year in the BCF group. Primary-assisted patency at 3, 6 and 12 months was better in the BCF group than BBF group (86%, 72% and 48% vs. 71%, 59%, 33%, respectively; p50.01) Primary functional and secondary patency rates at 3, 6 and 12 months were 74%, 58% and 32% and 78%, 63% and 41%, respectively, with an average of 0.33 procedures per AVF to maintain patency (10 fistuloplasties, 4 IR thrombectomy and 3 surgical thrombectomy). About 32% (n ¼ 17) of BBF were never used for HD (seven patients had a patent AVF but did not require HD418 months following creation; nine failed to adequately mature and one patient refused second stage superficialization). Conclusions BBF are associated with a significant initial operative burden and higher complication and poorer patency rates than BCF. About one-third of BBF created in this series were never used. Given the morbidity associated with this procedure, careful consideration should be given to creation of BBF in pre-dialysis patients particularly those in whom the rate of decline in renal function is slow. ARTICLE HISTORY

show abstract

Section: Utilization Of Avfcontrasting

confidence: 58%

Brachiobasilic fistulae: an upper limb autologous option for everyone?

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Use of arteries or veins ,1.5 mm in diameter is associated with higher AVF nonmaturation (53), prompting most surgeons to require arterial diameters .2 mm and venous diameters $2.5 mm. However, using even higher vascular diameters does not lower AVF nonmaturation (54). The effect of preoperative vascular diameters on AVG survival has not been reported.…”

Section: Answermentioning

confidence: 96%

A Patient with Recurrent Arteriovenous Graft Thrombosis

Allon¹

2015

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

Arteriovenous grafts (AVGs) are prone to frequent thrombosis that is superimposed on underlying hemodynamically significant stenosis, most commonly at the graft-vein anastomosis. There has been great interest in detecting AVG stenosis in a timely fashion and performing preemptive angioplasty, in the belief that this will prevent AVG thrombosis. Three surveillance methods (static dialysis venous pressure, flow monitoring, and duplex ultrasound) can detect AVG stenosis. Whereas observational studies have reported that surveillance with preemptive angioplasty substantially reduces AVG thrombosis, randomized clinical trials have failed to confirm such a benefit. There is a high frequency of early AVG restenosis after angioplasty caused by aggressive neointimal hyperplasia resulting from vascular injury. Stent grafts prevent AVG restenosis better than balloon angioplasty, but they do not prevent AVG thrombosis. Several pharmacologic interventions to prevent AVG failure have been evaluated in randomized clinical trials. Anticoagulation or aspirin plus clopidogrel do not prevent AVG thrombosis, but increase hemorrhagic events. Treatment of hyperhomocysteinemia does not prevent AVG thrombosis. Dipyridamole plus aspirin modestly decreases AVG stenosis or thrombosis. Fish oil substantially decreases the frequency of AVG stenosis and thrombosis. In patients who have exhausted all options for vascular access in the upper extremities, thigh AVGs are a superior option to tunneled internal jugular vein central vein catheters (CVCs). An immediate-use AVG is a reasonable option in patients with recurrent CVC dysfunction or infection. Tunneled femoral CVCs have much worse survival than internal jugular CVCs.Clin J Am Soc Nephrol 10: 2255-2262, 2015. doi: 10.2215/CJN.00190115 Patient PresentationThe following vignette illustrates the numerous challenges in optimizing arteriovenous graft (AVG) patency in hemodialysis patients. A 28-year-old woman initiated peritoneal dialysis when she developed ESRD because of focal glomerular sclerosis. She was hospitalized with an intracerebral bleed caused by a ruptured aneurysm 1.5 years later. A ventricular-peritoneal shunt was placed to treat hydrocephalus, and she was anticoagulated with warfarin to keep the shunt patent. Because of residual left-sided weakness and inadequate family support, she was no longer able to perform peritoneal dialysis. A tunneled central vein catheter (CVC) was placed in the right internal jugular vein, and she was switched to maintenance hemodialysis. A left forearm arteriovenous fistula (AVF) clotted 2 weeks after its creation. A subsequent looped left upper-arm AVG was successfully cannulated 5 weeks after its creation. It clotted four times during the ensuing 6 months and was treated each time by an interventional radiologist or nephrologist, who performed percutaneous thrombectomy, in conjunction with angioplasty of a venous anastomotic stenosis. The patient resumed hemodialysis with an internal jugular CVC when the AVG failed. A right radiocephalic AV...

show abstract

“…Studies conflict regarding the association between women, AVF nonmaturation, and reduced patency (6)(7)(8)(9), which is hypothesized to be related to smaller diameter veins in women compared with men. This is difficult to assess, because many studies do not perform preoperative vein mapping or report vein diameters.…”

Section: Demographicsmentioning

confidence: 99%

“…The varying definitions of maturation, patency, and techniques of measuring vein diameter likely contribute to the wide range of threshold diameters cited. To further complicate the situation, some authors have shown that there can be substantial overlap in the vein diameters of those whose AVF fail and those that succeed (7). Vein quality (e.g., distensibility) has not been studied extensively (59)(60)(61); however, the great majority of surgeons would not use a vein that appears sclerotic on either preoperative duplex ultrasound or direct examination.…”

Section: Vein Size/qualitymentioning

confidence: 99%

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Woo

2016

CJASN

101

View full text Add to dashboard Cite

Optimal vascular access planning begins when the patient is in the predialysis stages of CKD. The choice of optimal vascular access for an individual patient and determining timing of access creation are dependent on a multitude of factors that can vary widely with each patient, including demographics, comorbidities, anatomy, and personal preferences. It is important to consider every patient's ESRD life plan (hence, their overall dialysis access life plan for every vascular access creation or placement). Optimal access type and timing of access creation are also influenced by factors external to the patient, such as surgeon experience and processes of care. In this review, we will discuss the key determinants in optimal access type and timing of access creation for upper extremity arteriovenous fistulas and grafts.

show abstract

Outcomes of Brachiocephalic Fistulas, Transposed Brachiobasilic Fistulas, and Upper Arm Grafts

Cited by 109 publications

References 23 publications

Brachiobasilic fistulae: an upper limb autologous option for everyone?

Brachiobasilic fistulae: an upper limb autologous option for everyone?

A Patient with Recurrent Arteriovenous Graft Thrombosis

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

Contact Info

Product

Resources

About