Upper arm basilic vein elevation as a solution for forearm ulnar-basilic arteriovenous fistulae with cannulation problems

2018 ◽  
Vol 20 (3) ◽  
pp. 321-324
Author(s):  
Alexandros Mallios ◽  
William Jennings ◽  
Alessandro Costanzo ◽  
Benoit Boura ◽  
Myriam Combes
Keyword(s):  
Arteriovenous Fistula ◽  
Technical Note ◽  
Dialysis Access ◽  
Basilic Vein ◽  
Upper Arm ◽  
Arteriovenous Fistulae ◽  
Needle Position ◽  
Arterial Inflow

Background: Ulnar-basilic arteriovenous fistula is an alternative option when a radiocephalic arteriovenous fistula is not feasible. We review our technique of basilic vein transposition in the upper arm for difficult to puncture forearm ulnar-basilic non-transposed arteriovenous fistulae. Technical note: Three patients were referred for forearm ulnar-basilic arteriovenous fistulae with difficult cannulation where the forearm basilic vein was left in situ (non-transposed). Surgeon performed ultrasound examination confirmed a patent arteriovenous fistula with adequate diameter and flow, draining to the basilic vein in the forearm and into the upper arm. Recurrent new and resolving hematomas were present surrounding the forearm basilic vein resulting from difficult cannulation issues and problems maintaining needle position due the posterior-medial ulnar-basilic arteriovenous fistula position and mobility of the non-transposed forearm basilic vein. A basilic vein transposition elevation procedure was performed in the upper arm starting at the level of the elbow to a few centimeters below the axilla. Branches of the dilated basilic vein were ligated, the median cutaneous nerve was preserved, and the vein was elevated from its native position to a superficial and anterior location. Although difficult, dialysis access had been continued in the forearm during a brief period and none required catheter placement. Reliable dialysis access was successfully initiated using the newly transposed basilic vein in the upper arm 3–4 weeks after the procedure, maintaining arterial inflow based on the original ulnar-basilic arteriovenous fistula anastomosis at the wrist. None of the patients required further interventions with follow-up of 8, 15, and 22 months.

Technical note: An alternative method for AV access superficialization

2020 ◽  
Vol 21 (5) ◽  
pp. 760-763 ◽  
Author(s):  
Danielle Fontenot ◽  
Karl A Illig
Keyword(s):  
Adipose Tissue ◽  
Subcutaneous Tissue ◽  
Technical Note ◽  
Dialysis Access ◽  
Superficial Fascia ◽  
Arteriovenous Fistulae ◽  
Entire Area ◽  
Skin Breakdown ◽  
Lost To Follow Up

Introduction: An arteriovenous fistulae for dialysis access is only functional if superficial enough for reliable cannulation. We describe a previously unreported technique to superficialize arteriovenous fistulae too deep for reliable cannulation. Method: The path of the fistula is marked using ultrasound, and three to four transverse incisions are made along this path. The subcutaneous tissue is separated from the dermis over this entire area. The fistula is then accessed through transverse incisions and by dividing the overlying adipose tissue. The mobilized vein is then “trapped” directly under the dermis by closing the superficial fascia and adipose tissue beneath it and using this tissue to elevate the fistula. No anastomotic revisions are necessary, and moderate straightening can be performed. Results: We have performed this procedure on 20 patients with 100% technical success. One fistula had thrombosis within 8–10 weeks of the superficialization procedure and one patient refused access due to pain, but all other fistulas were successfully cannulated. Two patients were lost to follow-up, and one patient developed skin breakdown in the area of the flap which delayed cannulation. Our 3-month patency was 94.4% with a functional patency, defined as a clinically patent fistula successfully being used for hemodialysis, of 87.5%. Conclusion: The technique described allows elevation of the vein to the level of the dermis without division and re-anastomosis or re-tunneling, through several small incisions maintaining virgin skin and normal contour for easier cannulation.

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 Best Vascular Access in the Elderly: Time for Innovation?

2018 ◽  
Vol 47 (1-3) ◽  
pp. 236-239 ◽  
Author(s):  
Arif Asif ◽  
Mohamed M. Bakr ◽  
Michael Levitt ◽  
Tushar Vachharajani
Keyword(s):  
Arteriovenous Fistula ◽  
Ulnar Artery ◽  
The Elderly ◽  
Dialysis Access ◽  
Failure Rates ◽  
Early Failure ◽  
Upper Arm ◽  
Arteriovenous Access ◽  
Surgical Manipulation ◽  
Innovative Techniques

Background: Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. Summary: While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates. Two percutaneous innovative techniques that successfully establish fistulas at the upper arm using proximal radial/ulnar ­artery as the inflow have been recently introduced. These procedures have been successfully performed in the elderly. Importantly, these techniques bypass the open surgical exploration and as such avoid the surgical manipulation of the juxta-anastomotic region (a common cause for the development of juxta-anastomotic stenosis and early fistula failure). Key Message: This article discusses the arteriovenous fistula creation in the elderly, highlights the factors necessary for successful fistula creation, and describes the 2 innovative techniques that can be used to provide a robust platform for successful fistula creation in this population.

scholarly journals Outcome Following Hemorrhage From Cranial Dural Arteriovenous Fistulae

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Matthew J. Koch ◽  
Christopher J. Stapleton ◽  
Ridhima Guniganti ◽  
Giuseppe Lanzino ◽  
Jason Sheehan ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Dural Arteriovenous Fistula ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Morbidity And Mortality ◽  
Cerebrovascular Lesions ◽  
Arteriovenous Fistulae ◽  
Poor Outcome

Background and Purpose: Dural arteriovenous fistulae can present with hemorrhage, but there remains a paucity of data regarding subsequent outcomes. We sought to use the CONDOR (Consortium for Dural Arteriovenous Fistula Outcomes Research), a multi-institutional registry, to characterize the morbidity and mortality of dural arteriovenous fistula–related hemorrhage. Methods: A retrospective review of patients in CONDOR who presented with dural arteriovenous fistula–related hemorrhage was performed. Patient characteristics, clinical follow-up, and radiographic details were analyzed for associations with poor outcome (defined as modified Rankin Scale score ≥3). Results: The CONDOR dataset yielded 262 patients with incident hemorrhage, with median follow-up of 1.4 years. Poor outcome was observed in 17.0% (95% CI, 12.3%–21.7%) at follow-up, including a 3.6% (95% CI, 1.3%–6.0%) mortality. Age and anticoagulant use were associated with poor outcome on multivariable analysis (odds ratio, 1.04, odds ratio, 5.1 respectively). Subtype of hemorrhage and venous shunting pattern of the lesion did not affect outcome significantly. Conclusions: Within the CONDOR registry, dural arteriovenous fistula–related hemorrhage was associated with a relatively lower morbidity and mortality than published outcomes from other arterialized cerebrovascular lesions but still at clinically consequential rates.

scholarly journals In situ repair of vagus nerve stimulator lead damage: technical note

2016 ◽  
Vol 18 (6) ◽  
pp. 679-682 ◽  
Author(s):  
Ashley Ralston ◽  
Patti Ogden ◽  
Michael H. Kohrman ◽  
David M. Frim
Keyword(s):  
Vagus Nerve ◽  
Pulse Generator ◽  
Diagnostic Testing ◽  
Intractable Epilepsy ◽  
Electrode Array ◽  
Technical Note ◽  
Ablative Surgery ◽  
Impedance Testing

Vagus nerve stimulators (VNSs) are currently an accepted treatment for intractable epilepsy not amenable to ablative surgery. Battery death and lead damage are the main reasons for reoperation in patients with VNSs. In general, any damage to the lead requires revision surgery to remove the helical electrodes from the vagus nerve and replace the electrode array and wire. The electrodes are typically scarred and difficult to remove from the vagus nerve without injury. The authors describe 6 patients with VNSs who presented with low lead impedance on diagnostic testing, leading to the intraoperative finding of lead insulation disruption, or who were found incidentally at the time of implantable pulse generator battery replacement to have a tear in the outer insulation of the electrode wire. Instead of replacement, the wire insulation was repaired and reinforced in situ, leading to normal impedance testing. All 6 devices remained functional over a follow-up period of up to 87 months, with 2 of the 6 patients having a relatively shorter follow-up of only 12 months. This technique, applicable in a subset of patients with VNSs requiring lead exploration, obviates the need for lead replacement with its attendant risks.

Outcome after the Treatment of Spinal Dural Arteriovenous Fistulae: A Contemporary Single-institution Series and Meta-analysis

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Michael P. Steinmetz ◽  
Michael M. Chow ◽  
Ajit A. Krishnaney ◽  
Doreen Andrews-Hinders ◽  
Edward C. Benzel ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Retrospective Review ◽  
Initial Treatment ◽  
Dural Arteriovenous Fistula ◽  
Meta Analysis ◽  
Type I ◽  
Single Institution ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulae

Abstract OBJECTIVE: Spinal dural arteriovenous fistulae (Type I spinal AVMs) are the most common type of spinal vascular malformations. The optimal treatment strategy has yet to be defined, and endovascular embolization is being offered with increasing frequency. A 7-year single-institution retrospective review of outcome with surgical management of Type I spinal AVMs is presented along with a meta-analysis of existing literature. METHODS: For the institutional analysis, a retrospective review of all patients who underwent treatment at our institution for Type I spinal AVMs was performed. Between 1995 and the present (the time frame during which endovascular treatments were available), 19 consecutive patients were treated. Follow-up was performed by clinical examination or telephone interview, and functional status was measured by use of the Aminoff-Logue score. For the meta-analysis, a MEDLINE search between 1966 and the present was performed for surgical, endovascular, or combined treatment of spinal dural arteriovenous fistula. These series were included in a meta-analysis to evaluate success and failure rates, complications, and functional outcome. Specifically, embolization and microsurgery were compared. RESULTS: For the institutional analysis, 18 of 19 patients were available for long-term follow-up after surgery. There were no surgical failures, but one complication was seen. Patients demonstrated a statistically significant improvement in gait and bladder function after surgery. For the meta-analysis, 98% of those patients treated with microsurgery had their dural arteriovenous fistulae successfully obliterated after the initial treatment, compared with only 46% with embolization, as judged by radiographic or clinical follow-up. 89% percent of patients demonstrated improvement or stabilization in neurological symptoms after surgical treatment. Few complications were demonstrated with either surgery or embolization. CONCLUSION: At this point, surgery seems to be superior to embolization for the management of spinal dural arteriovenous fistula. The fistula is usually obliterated after the initial treatment, with few clinical or radiographic recurrences. The majority of patients either improve or stabilize after treatment. Few worsen, and the morbidity is minimal. It is reasonable to attempt initial embolization, especially at the time of the initial diagnostic spinal angiogram. The treating physicians and patients should be aware of the high chance of recurrence, and patients may ultimately require surgery or repeat embolization. After endovascular therapy, patients are committed to repeat angiography and probably embolization. For these reasons, it is the authors' opinion that surgery should be used as the first-line therapy for spinal dural arteriovenous fistulae.

scholarly journals Forearm loop arteriovenous grafts preserve and may create new upper arm access sites

2019 ◽  
Vol 20 (6) ◽  
pp. 691-696
Author(s):  
Nathan K Itoga ◽  
Whitt Virgin-Downy ◽  
Matthew W Mell
Keyword(s):  
Arteriovenous Fistula ◽  
Statistical Difference ◽  
Duplex Ultrasound ◽  
Arteriovenous Graft ◽  
Basilic Vein ◽  
Upper Arm ◽  
Arm Vein ◽  
Group A ◽  
Arteriovenous Grafts ◽  
Group B

Introduction: This study evaluated the mid-term patency of forearm loop arteriovenous grafts and the dilation of previously inadequate upper arm basilic and cephalic veins after failed forearm loop arteriovenous graft. Methods: All access procedures from September 2009 to December 2015 were reviewed. Vein mapping measurements were used to determine whether there was “adequate” upper arm cephalic and/or basilic vein, defined as ⩾3 mm by duplex ultrasound, at the time of forearm loop arteriovenous graft creation. Outcomes of forearm loop arteriovenous graft were compared with upper arm arteriovenous fistula, and primary and cumulative patencies were evaluated. Results: Thirty-eight forearm loop arteriovenous grafts and 278 upper arm arteriovenous fistulas were created. In the forearm loop arteriovenous graft cohort, nine were inserted with adequate upper arm vein, group A, and 29 were inserted with inadequate upper arm vein, group B. Cumulative patency was lower for forearm loop arteriovenous graft compared with upper arm arteriovenous fistula at 6 months, 1 year, and 2 years (67% vs 91%, 61% vs 85%, and 49% vs 80%, respectively, P < .01). Comparison of group A forearm loop arteriovenous graft and upper arm arteriovenous fistula did not show a statistical difference in cumulative patency at 6 months, 1 year, and 2 years (P = .80, .62, and .70, respectively). Of group B with failed forearm loop arteriovenous graft, 36% became candidates for upper arm arteriovenous fistula with dilation of ipsilateral upper arm cephalic or basilic vein to ⩾3 mm. Conclusion: In this study, forearm loop arteriovenous graft with adequate upper arm vein did not show a statistical difference in mid-term patencies compared with upper arm arteriovenous fistula. For those forearm loop arteriovenous grafts with inadequate upper arm vein, approximately one-third of patients became candidates for upper arm arteriovenous fistula demonstrating the benefits forearm loop arteriovenous graft.

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