Side-to-side arteriovenous fistula at the elbow with perforating vein ligation

Moini, Majıd; Williams, G. M.; Pourabbasi, Mohammad Sadegh; Tarighi, Payam; Mardanloo, Armita; Rayatzadeh, Hussein

doi:10.1016/j.jvs.2007.11.075

Cited by 15 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,6 In spite of the possibility to reduce the risk of distal venous hypertension and AVF-induced ischemia with perforator vein ligation, there is still no evidence on the rate of complications. [12][13][14] Only a few comparative studies have been published, usually not differentiating between proximal and distal AVF. Slightly better results have been related to SE anastomosis in six-month thrombosis (10.8% vs. 18.9%) and 24-month secondary patency (89.2% vs. 81.1%), 7 not confirmed in other registries, reporting higher operative times (75 vs. 50 min), bleeding risk (5.7% vs. 1.7%), and immediate access failure (7.5% vs. 2.5%) for SE accesses.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of side-to-end vs. side-to-side proximal arteriovenous fistula anastomosis in chronic renal failure patients

et al. 2019

View full text Add to dashboard Cite

Introduction Anastomotic creation of autogenous arteriovenous fistulas can be performed in different ways, side-to-end or side-to-side. However, there is a paucity of evidence to recommend them. The aim of this study is to compare both anastomosis types in elbow arteriovenous fistulas. Material and methods A prospective observational national multicenter study (ISRCTN62033470) was designed, including patients receiving a native arteriovenous fistula in the elbow using side-to-end or side-to-side anastomosis, between September, 2016 and September, 2017, with six-month postoperative follow-up period. Patient characteristics, surgical details, and follow-up data (primary, assisted primary and secondary patency, maturation, functionality, complications) were recorded and compared between both anastomosis groups using Kaplan–Meier curves estimations, at one and six-month follow-up, and finally a multivariate analysis with Cox regression was performed. Results Three centers participated in the study, including 133 cases (96 side-to-end, 37 side-to-side). The cephalic vein was more often used for side-to-end (58.3%) and basilic for side-to-side (78.4%; P < 0.001). Side-to-end anastomoses were faster to create (65.1–75.1 min; P = 0.009). During follow-up, 23 cases were lost (transplanted, dead, ligated, or lost), with no differences at one month. At six months, primary patency was better for the side-to-end group (78.5 − 55.9%; P = 0.038), but it was not confirmed as an independent predictor in the multivariate analysis. Furthermore, no significant differences in assisted primary or secondary patency, maturation or functionality were seen. Patients with side-to-side anastomosis more often required vein superficialization (2.1–16.2%; P = 0.002) and presented more frequent puncture hematomas (4.9–30.0%; P = 0.015). Conclusions Anastomosis type was not significantly related to different outcomes in the follow-up. Even though side-to-end anastomosis showed better primary patency at six months with lower need of vein superficialization and fewer puncture hematomas during follow-up, it was not confirmed as an independent predictor in the multivariate analysis, and similar assisted primary and secondary patency, maturation, and functionality rates have been seen after arteriovenous fistula creation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of side-to-end vs. side-to-side proximal arteriovenous fistula anastomosis in chronic renal failure patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The perforating vein is sometimes utilized for proximal forearm fistula for maintenance dialysis [4,5]. In spite of its usefulness in maintaining a patent forearm fistula in the case of poor upper arm superficial veins [6], ligation of the perforating vein is recommended when it is not used for anastomosis in the case of an antecubital fistula [7,8]. This is due to the concern that flow through the perforating vein may affect maturation by diverting blood to deeper structures.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of arteriovenous fistula-related venous hypertension: sonographic detection of a culprit perforating vein with movie and compact review

Kamata

Yamamoto

Okamura³

et al. 2016

Ren Replace Ther

View full text Add to dashboard Cite

Background: Venous hypertension is one of the critical complications of arteriovenous fistula (AV fistula). Here, we report an unusual variation of venous hypertension which was caused by retrograde outflow through a perforating vein of the elbow. Case presentation: A 79-year-old man with diabetic nephropathy had an AV fistula created at his left proximal forearm 2 years before referral. Shortly after the creation of the AV fistula, he developed swelling of the left hand and forearm. Six months prior to the referral, persistent pain of the left hand developed, and he visited the nephrology unit. An anastomosis of the AV fistula was located 5 cm distal to the elbow. Inspection, palpation, and auscultation did not suggest outflow stenosis. Ultrasound showed mature upper arm venous outflow without stenosis. His proximal radial artery had been anastomosed side-to-end to a nearby proximal forearm superficial vein. Color Doppler analysis revealed a retrograde outflow through an antecubital perforating vein, which drained into the deep portion of the forearm and then disappeared. Superficial veins of the left forearm had been exhausted due to a previous attempt to create a wrist AV fistula. Given the above, it was suspected that the unusual retrograde outflow through the perforating vein caused venous hypertension by interfering with the venous return of the forearm, which had been dependent on deep veins. The patient subsequently underwent ligation of the perforating vein. The day after the operation, the pain disappeared and swelling improved. The dialysis treatments were continued without problems. Conclusions: Retrograde outflow through a perforating vein can be a cause of venous hypertension in a patient with an AV fistula created using the proximal radial artery. Close sonographic examination of antecubital vessels should be done if a practitioner encounters unilateral whole forearm edema without apparent proximal outflow stenosis.

show abstract

“…In the elbow, beginning to construct an AVF with the perforating vein is the most advantageous (15). If any other elbow vein is used, perforating vein should be ligated in order to prevent flow to deep veins, to increase the flow into the superficial venous system (16, 17). If the perforating vein is not available or been used before, median cubital vein, its branches, median antecubital vein or other available nearby vein may be used, depending on the anatomy.…”

Section: Anatomymentioning

confidence: 99%

Elbow AVF configurations and indications

et al. 2017

View full text Add to dashboard Cite

show abstract

Side-to-side arteriovenous fistula at the elbow with perforating vein ligation

Abstract: We recommend this simple one-stage procedure for patients requiring hemodialysis whose cephalic vein at the wrist is unsuitable.

Cited by 15 publications

References 19 publications

Comparison of side-to-end vs. side-to-side proximal arteriovenous fistula anastomosis in chronic renal failure patients

Comparison of side-to-end vs. side-to-side proximal arteriovenous fistula anastomosis in chronic renal failure patients

An unusual case of arteriovenous fistula-related venous hypertension: sonographic detection of a culprit perforating vein with movie and compact review

Elbow AVF configurations and indications

Contact Info

Product

Resources

About