Superficialization of brachial artery as effective alternative vascular access

Abstract

Superficialization of the BA was found to be a simple and safe technique, with acceptable durability and complication rate in selected Japanese hemodialysis patients. We consider that this shuntless VA permits adequate blood flow and has theoretical advantages for some patients, particularly those with impaired cardiac function, though the availability of a return vein is a prerequisite for a functioning VA.

Arterial Access Port: A Shunt‐Less Vascular Access Using a Blind‐Ending Artificial Graft Anastomosed to the Brachial Artery

“…In the present study, the most conspicuous drawback of the AAP was the remarkable drop of its usage rates within one year after implantation, which was higher than that reported by Nakamura et al (15) for superficialized BA, even after eliminating the devastation of inflow veins as the cause of the withdrawal of its use. The main reasons for abandoning AAPs within a year were their bacterial infection and difficulty in the cannulation of AAPs followed by their inappropriate placement.…”

“…All of the complications could cause a serious risk of ischemia of the ipsilateral upper limb. There are a few reports of such complications caused by direct puncture of superficialized arteries . In our series, surgical repairs for bacterial infection and pseudoaneurysm of AAPs were required in five patients, but all of them underwent closure of the anastomotic wall defect using running suture following the removal of the AAPs, and their BA flow could be maintained.…”

“…As the years on hemodialysis increased from <2 years to ≥25 years, the proportion of patients in whom arterial superficialization was used as a form of VA increased from 1.6% to 4.3% . Therefore, the trend of longer hemodialysis period in Japan than in other countries, which was caused by chronic donor shortage for kidney transplantation and the healthcare insurance system in Japan, could be considered the trigger that expanded the use of BA superficialization for VA in Japan .…”

“…This enabled the patients with AAP to continue and extend their AAP usage period as the secondary functional usage, and the maximal secondary usage period of the patients with reconstructed AAP was 97 months. To increase the functional patency rate, the superficialized BAs could be dilated using endovascular treatment for the stenosis of the cannulation site; however, their reuse after surgical repairs for complications such as infection, aneurysm, and occlusion is considered difficult, because there has been no report describing the secondary functional patency rate of a superficialized artery . The third was that the minimum BA diameter of 3.0 mm or more could enable the creation of an AAP, because the blood drawing space contained intra‐AAP blood inflow besides the BA lumen around the anastomosis, although a superficialized artery diameter greater than 4.0 or 4.5 mm was recommended for their easy and safe cannulation .…”

“…Arterial superficialization has been considered as a VA option since the late 1960s, but this method is not well‐known worldwide . Nakamura et al from Japan recently reported the long‐term results of superficialization of the BA as an outflow VA with 66% of its cumulative functional patency rate at 3 years after the operation; however, direct puncture of the superficialized BA is associated with the risk of stricture, thrombosis, and occlusion of the needled BA.…”