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Side-to-side arteriovenous fistula at the elbow with perforating vein ligation.| Authors: | Majid Moini, G Melville Williams, Mohammad Sadegh Pourabbasi, Mohammad Reza Rasouli, Payam Tarighi, Armita Mardanloo, Hussein Rayatzadeh | | Language: | Eng. | | Date: | 02-06-2008 | | Journal: | Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
(0741-5214)
| | Release: | J Vasc Surg. 2008 Jun;47(6):1274-8 | |
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Abstract:
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OBJECTIVE:
We postulated that ligation of a consistent perforating venous branch at the elbow would improve distention and flow in the superficial veins about the elbow. This would also lesson the likelihood of arterial steal enabling a favorable outcome following a brachial artery medial antecubital or cephalic vein arterio-venous fistula (AVF).
METHODS:
Pressure measurements were made from the radial artery after side-to-side brachial artery antecubital or cephalic vein AVF in 20 patients. Clamping of the perforating vein increased radial artery pressure significantly indicating that a considerable amount of flow from the side-to-side AVF was diverted into the deep system and away from the accessible superficial veins. Encouraged by this finding, we studied the outcome of brachial cephalic or brachial antecubital AVF with ligation of the deep branch in 134 patients who were not candidates for radio-cephalic AVF. The end point of the study was successful hemodialysis using the fistula.
RESULTS:
Of the 134 patients treated, 24 died, and 11 were lost to follow-up and were censored from analysis of fistula performance at that time point. The primary fistula success rate was 89.7% +/- 2.66% and 83.7% +/- 3.5% at 1 and 2 years by life table analysis. No patient developed significant arterial steal or venous hypertension.
CONCLUSION:
We recommend this simple one-stage procedure for patients requiring hemodialysis whose cephalic vein at the wrist is unsuitable.
| | Copyright: | Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
Division of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. | | Full text: |  EBSCO - HTML (needs subscription) | | |
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