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.

Placement, Performance and Complications of the Ash Split Cath™ Hemodialysis Catheter

2002 ◽  
Vol 25 (12) ◽  
pp. 1137-1143 ◽  
Author(s):  
M. Gallieni ◽  
P.A. Conz ◽  
E. Rizzioli ◽  
A. Butti ◽  
D. Brancaccio
Keyword(s):  
Vascular Access ◽  
Good Alternative ◽  
Chronic Hemodialysis ◽  
Dialysis Session ◽  
Dialysis Dose ◽  
Hemodialysis Catheter ◽  
Venous Fistula ◽  
Tunneled Catheter ◽  
Urea Reduction Ratio

A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath™, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron® cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 ± 20 ml/min at 1 week after insertion, 306 ± 17 ml/min at 3 months, 299 ± 44 ml/min at 6 months, and 308 ± 16 ml/min at 12 months. With a mean dialysis session duration of 234 ± 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71%±8 or a mean urea kinetic modeling, or Kt/V, value of 1.51±0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement.

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.

scholarly journals Brachio- Axillary Translocation Fistula with Reverse Saphenous Venous Graft: a New Hope for the Patients of End stage Renal Disease

2018 ◽  
Vol 33 (2) ◽  
pp. 134-137
Author(s):  
SMG Saklayen Russel ◽  
Jubayer Ahmad ◽  
Raju Ahmed ◽  
Jashim Uddin ◽  
Suman Nazmul Hosain
Keyword(s):  
Upper Limb ◽  
Brachial Artery ◽  
Proximal Part ◽  
Fistula Formation ◽  
Axillary Vein ◽  
Av Fistula ◽  
Venous Fistula ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Native arterio-venous fistula (AVF) are the preferred mode of repeated vascular access for the chronic renal failure patients surviving on hemodialysis because of their easy accessibility, good long term patency, low complication rate and cost-effectiveness. Creation of a fistula between the radial or brachial artery and a suitable adjacent vein is the most commonly practiced option. However the major upper arm veins of the CKD patients are often found thrombosed, cord like and not suitable for AV anastomosis. A 48 years old male patient of chronic kidney disease with a permanent catheter placed in the right subclavian vein was referred to create an AV fistula. On exploration none of the upper limb veins was found suitable for fistula formation. The proximal part of the left GSV was harvested from patient’s left upper thigh and was used to make a connection between left brachial artery at cubital fossa and the left axillary vein. To avoid over flooding of the limb vasculature, partial banding of the left axillary vein was done distal to this anastomosis. When all options in both upper limbs are exhausted, autologous great saphenous grafts may be a very useful tool for the surgeons in creating upper limb AV fistulas in difficult situations Bangladesh Heart Journal 2018; 33(2) : 134-137

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

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 Morphological feature of brachial artery and its clinical significance

2015 ◽  
Vol 32 (03) ◽  
pp. 129-134
Author(s):  
W. Al Talalwah ◽  
D. Getachew ◽  
R. Soames
Keyword(s):  
Clinical Significance ◽  
Upper Limb ◽  
Brachial Artery ◽  
Surgical Complication ◽  
Ulnar Artery ◽  
Internal Diameter ◽  
Terminal Branch ◽  
External Diameter ◽  
Venous Fistula ◽  
The Right

Abstract Introduction: The present study is to provide comprehensive data concerning the morphology of brachial artery which has a clinical significance for clinicians, orthopedics, vascular surgeons and anatomists. Materials and Methods: Routine dissections of the right and left upper limb of 34 adult cadavers (20 male and 14 female: mean age 78.9 year) were undertaken. It investigates the characteristics of the brachial artery such as the internal diameter, external diameter, wall thickness and distance of bifurcation of brachial artery. Results: The mean of the external and internal diameters of the brachial artery from proximal to distal ranged from 6.87-5.35 mm respectively. The bifurcation of the brachial artery from the head of radius into its terminal branch radial and ulnar artery ranged from 13.49-13.79 mm, while the distance of bifurcation of common interosseous from origin of the ulnar artery ranged from 33.11-33.45 mm. The angle of bifurcation ofthe radial and ulnar arteries from the brachial artery ranged from 5.79-7.33° and 18.640-19.36° respectively. Due to variability of the brachial artery in the upper limb, the surgical and invasive procedures are performed in the region such as artiicial arterial-venous fistula become more difficult and may result in iatrogenic injury. Conclusion: Therefore, it is a clinical significant for surgeons to known the variable morphology and course of brachial artery to minimize surgical complication prior to operation.

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.

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

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 198-200 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document