The forearm arteriovenous graft between the brachial artery and the brachial vein as a reliable dialysis vascular access for patients with inadequate superficial veins

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2–3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.

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SP580THE ARTERIOVENOUS GRAFT BETWEEN THE BRACHIAL ARTERY AND VENA COMITANS: A RELIABLE VASCULAR ACCESS IN PATIENTS WITH INADEQUATE SUPERFICIAL VEINS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx153.sp580 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii329-iii330

Author(s):

Giordano Fumagalli ◽

Stefano De Pietro ◽

Massimiliano Migliori ◽

Vincenzo Panichi

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Arteriovenous Graft

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A Case of Brachial Artery Thrombosis Caused by Massage of an Occluded Arteriovenous Graft

Kidney and Dialysis ◽

10.3390/kidneydial1010011 ◽

2021 ◽

Vol 1 (1) ◽

pp. 74-78

Author(s):

Taisuke Matsue ◽

Yoshikazu Kuroki ◽

Toshihide Naganuma ◽

Yoshiaki Takemoto ◽

Junji Uchida

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Surgical Intervention ◽

Treatment Options ◽

Limb Ischemia ◽

Vascular Wall ◽

Arteriovenous Graft ◽

Case Presentation ◽

Artery Thrombosis ◽

Appropriate Treatment

Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case Presentation: The patient was a 43-year-old woman with renal failure who underwent hemodialysis and peritoneal dialysis. She was found to have an arteriovenous graft (AVG) thrombosis at the start of a hemodialysis session. She underwent massage of the vascular access, and immediately after the massage, she reported pain and cyanosis in her right-hand fingers and was referred to our hospital. Duplex ultrasonography revealed a large number of thrombi in the brachial, radial and ulnar arteries. AULI due to brachial artery thrombosis was diagnosed and surgical intervention was performed on the same day. The vascular wall of the forearm artery was incised vertically against the running vessel and thrombi around the bifurcation of the radial and ulnar arteries were removed. Angiography guided-surgical intervention was performed and improvement in blood flow was achieved. The patient was discharged on the second day after the operation. Conclusion: Surgical intervention has been reported as an effective treatment of AULI due to brachial artery thrombosis after massage of an occluded vascular access.

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Peripheral vascular access from the arms for invasive cardiac investigation using ultrasound guidance

European Heart Journal ◽

10.1093/eurheartj/ehab724.0377 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Kadiwar ◽

J Griffiths ◽

S Ailoaei ◽

B Barton ◽

N Samchkuashvili ◽

...

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Complication Rates ◽

Basilic Vein ◽

Portable Ultrasound ◽

Coronary Interventions ◽

Increased Risk ◽

Brachial Vein ◽

Sheath Insertion ◽

The Right

Abstract Introduction Vascular access for invasive cardiac investigations has traditionally been gained from the femoral vessels, however, a “radial-first” approach has become increasingly popular for coronary interventions [1]. Transradial access has shown lower complication rates, shorter admission times, and reduced healthcare costs for coronary interventions [4]. A “superior” approach via the jugular and subclavian veins have been reported for electrophysiology (EP) studies and radiofrequency catheter ablation (RFCA) but is associated with an increased risk of complications such as pneumo- and haemothorax [9]. Purpose EP procedures often require the use of both venous and arterial catheters, and the potential advantage of non-femoral peripheral access is yet to be investigated. This study was performed to provide comprehensive anatomical evidence that the vessels of the arms are suitable for use during EP procedures, as assessed by vascular ultrasound. Methods A portable ultrasound device was used to measure the diameter of the brachial artery, brachial vein, basilic vein & cephalic vein on the left and right upper limbs of 63 healthy adult volunteers. Measurements were also taken of the circumference at the elbow and at the mid-bicep level on both arms. A subgroup of 15 volunteers had additional measurements taken of the same veins and artery on both arms with a tourniquet at the upper bicep level. Results The basilic vein was found to have the largest diameter with a median of 4.6 mm and 4.5 mm (right and left diameter, respectively), followed by the cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8 mm for both arms). 100% of volunteers had at least one vein that was equal to a 3 mm diameter (which would allow for a 8F sheath insertion), with 98% having 2 suitable veins and >80% having 3 suitable venous vessels. More than 90% had a suitable diameter of more than 3 mm for both the right and left brachial artery. There was significant correlation between gender, and basilic vein and brachial artery diameters. There was no correlation between BMI, height, weight and elbow or bicep circumference. Conclusion To our knowledge, this is the first study to investigate the feasibility of adopting peripheral access in the electrophysiology lab. 100% of volunteers examined had one vein which was at least 3mm in size and would be suitable for 8F sheath insertion. We demonstrate the anatomic evidence that the vessels in the arm are capable of housing the size of sheath and catheters commonly used in the EP lab. FUNDunding Acknowledgement Type of funding sources: None. Figure 2. measurements Figure 3. Vessel diameters

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Peripheral vascular access from the arms for electrophysiology procedures using ultrasound guidance

10.22541/au.161865182.29595670/v1 ◽

2021 ◽

Author(s):

Suraj Kadiwar ◽

Jack Griffiths ◽

Stefan Ailoaei ◽

Bruce Barton ◽

Nelly Samchkuashvili ◽

...

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Complication Rates ◽

Portable Ultrasound ◽

Increased Risk ◽

Lower Complication ◽

Femoral Vessels ◽

Brachial Vein ◽

The Right ◽

Superior Approach

Introduction Vascular access has traditionally been gained from the femoral vessels, however, a ‘radial-first’ approach has become increasingly popular and resulted in lower complication rates and reduced healthcare costs. A “superior” approach has been reported for electrophysiology (EP) studies but is associated with an increased risk. To provide comprehensive anatomical evidence that the vessels of the arms are suitable for use during EP procedures, as assessed by vascular ultrasound. Methods A portable ultrasound device was used to measure the diameter of the brachial artery, brachial, basilic & cephalic veins on the left and right upper limbs of 63 healthy volunteers. A subgroup of 15 volunteers had additional measurements taken with a tourniquet. Results The basilic vein had the largest diameter with a median of 4.6 mm and 4.5 mm (right and left diameter, respectively), followed by the cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8 mm). 100% of volunteers had at least one vein that was equal to a 3 mm diameter (which would allow for an 8F sheath), with 98% having 2 suitable veins and >80% having 3 suitable venous vessels. More than 90 % had a suitable diameter for both the right and left brachial artery. There was no correlation between BMI, height, weight, but men had significantly larger basilic veins and brachial arteries (p<0.05). Conclusion We demonstrate the anatomic evidence that the vessels in the arm(s) are capable of housing the size of sheath commonly used in the EP lab.

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Pseudoaneurysm of the brachial artey in two infants following accidental artertial puncture

VASA ◽

10.1024/0301-1526.34.3.198 ◽

2005 ◽

Vol 34 (3) ◽

pp. 198-200 ◽

Cited By ~ 1

Author(s):

Yilmaz ◽

Dogan ◽

Tok ◽

Hazirolan ◽

Guvener ◽

...

Keyword(s):

Blunt Trauma ◽

Vascular Access ◽

Brachial Artery ◽

Fibrous Tissue ◽

Arterial Puncture ◽

Artery Pseudoaneurysm

A pseudoaneurysm is defined as an aneurysmatic sac surrounded by fibrous tissue instead of other vascular layers such as the muscular one. It is a rare incident in infants especially in the brachial artery. Blunt trauma and vascular access attempts are the most common etiologic factors. We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture.

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Estimation of culprit lesion using brachial artery RI and radial artery RI by ultrasound-guided vascular access

Choonpa Igaku ◽

10.3179/jjmu.jjmu.a.118 ◽

2018 ◽

Vol 45 (6) ◽

pp. 605-610

Author(s):

Masahito MINAMI ◽

Mayu TUJIMOTO ◽

Ayako NISHIMOTO ◽

Mika SAKAGUCHI ◽

Yasuhiro OONO ◽

...

Keyword(s):

Radial Artery ◽

Vascular Access ◽

Brachial Artery ◽

Culprit Lesion ◽

Ultrasound Guided

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Faculty Opinions recommendation of Brachial artery ligation with total graft excision is a safe and effective approach to prosthetic arteriovenous graft infections.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1124479.581672 ◽

2008 ◽

Author(s):

Fred Weaver ◽

Sukgu Han

Keyword(s):

Brachial Artery ◽

Arteriovenous Graft ◽

Artery Ligation

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Forearm brachial artery to brachial vein looped arteriovenous grafts: A single center, single surgeon observational study

The Journal of Vascular Access ◽

10.1177/11297298211015095 ◽

2021 ◽

pp. 112972982110150

Author(s):

Jeremy Liu ◽

Josiah Situmeang ◽

Devin Takahashi ◽

Russell Harada

Keyword(s):

Primary Patency ◽

The Body ◽

Secondary Patency ◽

Close Monitoring ◽

Arteriovenous Graft ◽

Inclusion Criteria ◽

Kaplan Meier ◽

Brachial Vein ◽

Arteriovenous Grafts

Background: Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon’s experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs. Methods: We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan–Meier method. The incidence of complications and interventions were expressed as number of events per person-year. Results: A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year). Conclusion: In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.

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Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

The Journal of Vascular Access ◽

10.1177/1129729820965064 ◽

2021 ◽

pp. 112972982096506

Author(s):

Eva Chytilova ◽

Tamara Jemcov ◽

Jan Malik ◽

Jernej Pajek ◽

Branko Fila ◽

...

Keyword(s):

Vascular Access ◽

Doppler Ultrasonography ◽

Arteriovenous Graft ◽

Central Venous ◽

Preoperative Mapping ◽

High Incidence ◽

Arteriovenous Access ◽

Ultrasound Parameters ◽

Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

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