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

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

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

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.

Anatomical variations in upper arm vasculature pertinent to haemodialysis access creation: are surgeons aware sufficiently?

2020 ◽  
pp. 1-14
Author(s):  
Zia Ur Rehman ◽  
Zainab Majid ◽  
Laila Tul Qadar ◽  
Aamina Majid
Keyword(s):  
Arteriovenous Fistula ◽  
Brachial Artery ◽  
End Stage Renal Disease ◽  
Anatomical Variations ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Increased Risk ◽  
Brachial Vein ◽  
Stage Renal Disease ◽  
End Stage

Abstract There exist wide anatomical variations of upper limb. Their implication is perhaps greatest when it comes to failure of arteriovenous fistula (AVF) for chronic hemodialysis. Among arteries of forearm, brachial artery is of note, whose high bifurcation is associated with increased risk of failure. The superficial and accessory variants also cause difficulty for the surgeon. The single unpaired brachial vein and stenosis of cephalic vein compound the difficulties associated with AVF among many others. A thorough understanding of surgeons regarding normal anatomy and diverse variants holds high importance in context of deciding an appropriate site for arteriovenous (AV) anastomosis. Negligence in creation of fistula not only pose a threat to patients of end stage renal disease (ERSD) but also contributes to numerous other complications involving nerves and drug administration. Keywords: Brachial artery; basilic vein; arteriovenous fistula; vascular variations. Continuous....

Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

2003 ◽  
Vol 4 (1) ◽  
pp. 21-24 ◽  
Author(s):  
M. Onaran ◽  
D. Erer ◽  
I. Şen ◽  
E.E. Elnur ◽  
E. Iriz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
Subcutaneous Tissue ◽  
Vascular Grafts ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

scholarly journals Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

2018 ◽  
Vol 146 (5-6) ◽  
pp. 316-319
Author(s):  
Branislav Donfrid ◽  
Olivera Lozance ◽  
Zvezdan Stefanovic ◽  
Aleksandar Jankovic ◽  
Nada Dimkovic
Keyword(s):  
Vascular Access ◽  
Brachial Artery ◽  
Duplex Sonography ◽  
Distal Region ◽  
Original Method ◽  
Late Complications ◽  
Primary Patency ◽  
Chronic Hemodialysis ◽  
Secondary Patency ◽  
Basilic Vein

Introduction. The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline. The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion. AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.

Brachio-brachial arteriovenous fistula combined with superficialization of the brachial artery using a short skin incision for hemodialysis

2020 ◽  
pp. 112972982094408
Author(s):  
Tsuyoshi Takashima ◽  
Yui Nakashima ◽  
Atsuhiko Suenaga ◽  
Yuki Yamashita ◽  
Yasunori Nonaka ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
English Literature ◽  
Invasive Procedure ◽  
Skin Incision ◽  
Related Data ◽  
One Stage ◽  
Long Time ◽  
Brachial Vein

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.

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

2019 ◽  
Vol 70 (1) ◽  
pp. 199-207.e4
Author(s):  
Giordano Fumagalli ◽  
Fabio Trovato ◽  
Massimiliano Migliori ◽  
Vincenzo Panichi ◽  
Stefano De Pietro
Keyword(s):  
Vascular Access ◽  
Brachial Artery ◽  
Arteriovenous Graft ◽  
Brachial Vein

scholarly journals Brachial artery perforator propeller flap reconstruction of post electrical burn defect axilla

2021 ◽  
Vol 8 (10) ◽  
pp. 3211
Author(s):  
Surya Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Brachial Artery ◽  
Preoperative Planning ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Complication Rates ◽  
Vascular Pedicle ◽  
Propeller Flap ◽  
Current Scenario ◽  
The Right ◽  
Artery Perforator

In the current scenario, propeller flaps are an attractive choice for single stage coverage of a large number of defects. They have a more reliable vascular pedicle than traditional flap and allow for greater freedom in design and wide mobilization and minimal donor-site morbidity. Harvesting of a propeller flap requires appropriate patient selection, preoperative planning, and meticulous dissection and these techniques greatly reduce the complication rates. Here, we present a case of a post burn raw area of the right axilla which was debrided and covered with a brachial artery perforator propeller flap.

scholarly journals Minimal incision superficialization of the brachial artery: a technical note

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Yohei Kawatani ◽  
Atsushi Oguri
Keyword(s):  
New York ◽  
Vascular Access ◽  
Brachial Artery ◽  
Technical Note ◽  
Chronic Hemodialysis ◽  
Barbed Suture ◽  
Nyha Classification ◽  
Minimal Incision ◽  
Venous Fistula ◽  
The Right

Abstract The Japanese Society for Dialysis Therapy recommends superficialization of the brachial artery (BA) for vascular access in patients with comorbidities. We describe a novel minimal incision superficialization surgery of a BA through a single small incision. A 78-year-old male, who underwent chronic hemodialysis through an arterio-venous fistula, was transferred to our hospital for treatment of heart failure. We chose superficialization of the right BA for new vascular access. Under tumescent local analgesia, though a single 2-cm long incision, the BA was superficialized for 10-cm long. To complete procedures in the narrow and deep space, vessel branches were ligated by vascular clip and knot-less barbed suture was applied for closure of the brachial fascia beneath the BA. The hemodynamic status during the hemodialysis improved and the New York Heat Association (NYHA) classification grade improved from IV to II. This technique can be an alternative for arterio-venous fistula in patients with comorbidities.

Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

2003 ◽  
Vol 4 (1) ◽  
pp. 21-24
Author(s):  
M. Onaran ◽  
D. Erer ◽  
I. Şen ◽  
E.E. Elnur ◽  
E. Iriz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
Subcutaneous Tissue ◽  
Vascular Grafts ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

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