Arteriovenous Access superficialization: A New Technique and Review of Options.
Arteriovenous Shunt, Surgical
Brachial Artery
/ diagnostic imaging
Catheterization
Dissection
/ adverse effects
Female
Humans
Male
Radial Artery
/ diagnostic imaging
Renal Dialysis
Retrospective Studies
Treatment Outcome
United States
Upper Extremity
/ blood supply
Vascular Patency
Veins
/ diagnostic imaging
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
27
10
2019
revised:
06
05
2020
accepted:
08
05
2020
pubmed:
2
6
2020
medline:
1
12
2020
entrez:
2
6
2020
Statut:
ppublish
Résumé
Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques. The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and "trapped" directly under the dermis by closing the superficial fascia and adipose tissue beneath it. Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8-10 weeks after superficialization. This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature.
Sections du résumé
BACKGROUND
BACKGROUND
Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques.
METHODS
METHODS
The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and "trapped" directly under the dermis by closing the superficial fascia and adipose tissue beneath it.
RESULTS
RESULTS
Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8-10 weeks after superficialization.
CONCLUSIONS
CONCLUSIONS
This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature.
Identifiants
pubmed: 32479883
pii: S0890-5096(20)30427-1
doi: 10.1016/j.avsg.2020.05.020
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
43-51Informations de copyright
Published by Elsevier Inc.