Vein transposition in the forearm for autogenous hemodialysis access
Purpose: We describe a technique of superficial venous transposition in the forearm used for the formation of an arteriovenous fistula for hemodialysis access. These modifications of the single-incision radiocephalic fistula are designed to increase options for arteriovenous fistulas by using veins...
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| Veröffentlicht in: | Journal of vascular surgery 1997-12, Vol.26 (6), p.981-988 |
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| container_title | Journal of vascular surgery |
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| creator | Silva, Michael B. Hobson, Robert W. Pappas, Peter J. Haser, Paul B. Araki, Clifford T. Goldberg, Mark C. Jamil, Zafar Padberg, Frank T. |
| description | Purpose: We describe a technique of superficial venous transposition in the forearm used for the formation of an arteriovenous fistula for hemodialysis access. These modifications of the single-incision radiocephalic fistula are designed to increase options for arteriovenous fistulas by using veins and arteries that are suitable for use but are not in immediate proximity.
Methods: Arteries and veins suitable for a primary arteriovenous fistula were identified and mapped using duplex ultrasound in 89 patients. Separate incisions were used in the majority of cases, and the selected forearm vein was mobilized, angiodilated, and transposed into a subcutaneous tunnel on the volar aspect of the forearm. Before initiation of hemodialysis, duplex ultrasound scanning was performed, and the location that was most suitable for cannulation was identified. Repeat scans were performed at 3-month intervals for analysis of patency.
Results: Superficial venous transpositions were performed using a single incision in 13 instances in which the vein was in immediate proximity to the radial artery (type A). Dorsal-to-volar forearm transposition (type B) was performed in 30 veins with anastomoses to the radial (n = 26), ulnar (n = 2), or brachial (n = 2) arteries. Volar-to-volar forearm transposition (type C) was performed in the remaining 46 veins, with anastomoses to the radial (n = 42), ulnar (n = 2), or brachial arteries (n = 2). Successful hemodialysis was accomplished in 81 of 89 patients (91%). The primary cumulative patency rate was 84% at 1 year and 69% at 2 years. The mean duration of follow-up was 14.3 months.
Conclusions: The use of superficial venous transposition for the formation of autogenous hemoaccess was associated with ease of cannulation by dialysis personnel, high maturation rates, reduced early failure rates, and enhanced patency rates. We recommend the use of these technical modifications to increase the use of autogenous fistulas in the forearm. (J Vasc Surg 1997;26:981-8.) |
| doi_str_mv | 10.1016/S0741-5214(97)70010-7 |
| format | Article |
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Methods: Arteries and veins suitable for a primary arteriovenous fistula were identified and mapped using duplex ultrasound in 89 patients. Separate incisions were used in the majority of cases, and the selected forearm vein was mobilized, angiodilated, and transposed into a subcutaneous tunnel on the volar aspect of the forearm. Before initiation of hemodialysis, duplex ultrasound scanning was performed, and the location that was most suitable for cannulation was identified. Repeat scans were performed at 3-month intervals for analysis of patency.
Results: Superficial venous transpositions were performed using a single incision in 13 instances in which the vein was in immediate proximity to the radial artery (type A). Dorsal-to-volar forearm transposition (type B) was performed in 30 veins with anastomoses to the radial (n = 26), ulnar (n = 2), or brachial (n = 2) arteries. Volar-to-volar forearm transposition (type C) was performed in the remaining 46 veins, with anastomoses to the radial (n = 42), ulnar (n = 2), or brachial arteries (n = 2). Successful hemodialysis was accomplished in 81 of 89 patients (91%). The primary cumulative patency rate was 84% at 1 year and 69% at 2 years. The mean duration of follow-up was 14.3 months.
Conclusions: The use of superficial venous transposition for the formation of autogenous hemoaccess was associated with ease of cannulation by dialysis personnel, high maturation rates, reduced early failure rates, and enhanced patency rates. We recommend the use of these technical modifications to increase the use of autogenous fistulas in the forearm. (J Vasc Surg 1997;26:981-8.)</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/S0741-5214(97)70010-7</identifier><identifier>PMID: 9423713</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Arteriovenous Shunt, Surgical - methods ; Brachial Artery - surgery ; Female ; Forearm - blood supply ; Forearm - surgery ; Humans ; Life Tables ; Male ; Middle Aged ; Radial Artery - surgery ; Renal Dialysis ; Treatment Outcome ; Ulnar Artery - surgery ; Veins - surgery</subject><ispartof>Journal of vascular surgery, 1997-12, Vol.26 (6), p.981-988</ispartof><rights>1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-436f91d52db24b73b6b0f07637f263cc08d94a19bda2ffb26499de7fbd2dfef93</citedby><cites>FETCH-LOGICAL-c407t-436f91d52db24b73b6b0f07637f263cc08d94a19bda2ffb26499de7fbd2dfef93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0741-5214(97)70010-7$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9423713$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silva, Michael B.</creatorcontrib><creatorcontrib>Hobson, Robert W.</creatorcontrib><creatorcontrib>Pappas, Peter J.</creatorcontrib><creatorcontrib>Haser, Paul B.</creatorcontrib><creatorcontrib>Araki, Clifford T.</creatorcontrib><creatorcontrib>Goldberg, Mark C.</creatorcontrib><creatorcontrib>Jamil, Zafar</creatorcontrib><creatorcontrib>Padberg, Frank T.</creatorcontrib><title>Vein transposition in the forearm for autogenous hemodialysis access</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Purpose: We describe a technique of superficial venous transposition in the forearm used for the formation of an arteriovenous fistula for hemodialysis access. These modifications of the single-incision radiocephalic fistula are designed to increase options for arteriovenous fistulas by using veins and arteries that are suitable for use but are not in immediate proximity.
Methods: Arteries and veins suitable for a primary arteriovenous fistula were identified and mapped using duplex ultrasound in 89 patients. Separate incisions were used in the majority of cases, and the selected forearm vein was mobilized, angiodilated, and transposed into a subcutaneous tunnel on the volar aspect of the forearm. Before initiation of hemodialysis, duplex ultrasound scanning was performed, and the location that was most suitable for cannulation was identified. Repeat scans were performed at 3-month intervals for analysis of patency.
Results: Superficial venous transpositions were performed using a single incision in 13 instances in which the vein was in immediate proximity to the radial artery (type A). Dorsal-to-volar forearm transposition (type B) was performed in 30 veins with anastomoses to the radial (n = 26), ulnar (n = 2), or brachial (n = 2) arteries. Volar-to-volar forearm transposition (type C) was performed in the remaining 46 veins, with anastomoses to the radial (n = 42), ulnar (n = 2), or brachial arteries (n = 2). Successful hemodialysis was accomplished in 81 of 89 patients (91%). The primary cumulative patency rate was 84% at 1 year and 69% at 2 years. The mean duration of follow-up was 14.3 months.
Conclusions: The use of superficial venous transposition for the formation of autogenous hemoaccess was associated with ease of cannulation by dialysis personnel, high maturation rates, reduced early failure rates, and enhanced patency rates. We recommend the use of these technical modifications to increase the use of autogenous fistulas in the forearm. (J Vasc Surg 1997;26:981-8.)</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arteriovenous Shunt, Surgical - methods</subject><subject>Brachial Artery - surgery</subject><subject>Female</subject><subject>Forearm - blood supply</subject><subject>Forearm - surgery</subject><subject>Humans</subject><subject>Life Tables</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Radial Artery - surgery</subject><subject>Renal Dialysis</subject><subject>Treatment Outcome</subject><subject>Ulnar Artery - surgery</subject><subject>Veins - surgery</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMtOwzAQRS0EKqXwCZWyQrAI2M7D9QqhqjwkJBY8tpYfY2qUxMVOkPo3fAtfRtJW3bK60syduTMHoSnBVwST8voFs5ykBSX5BWeXDGOCU3aAxgRzlpYzzA_ReG85RicxfvYeUszYCI14TjNGsjFavINrkjbIJq58dK3zTTIUlpBYH0CGetBEdq3_gMZ3MVlC7Y2T1Tq6-PsjtYYYT9GRlVWEs51O0Nvd4nX-kD493z_Ob59SnWPWpnlWWk5MQY2iuWKZKhW2mJUZs7TMtMYzw3NJuDKSWqtomXNugFllqLFgeTZB59u9q-C_OoitqF3UUFWygf42wXiBM1wUvbHYGnXwMQawYhVcLcNaECwGfGKDTwxsBGdig0-wfm66C-hUDWY_tePV92-2fei__HYQRNQOGg3GBdCtMN79k_AHq5GBOg</recordid><startdate>19971201</startdate><enddate>19971201</enddate><creator>Silva, Michael B.</creator><creator>Hobson, Robert W.</creator><creator>Pappas, Peter J.</creator><creator>Haser, Paul B.</creator><creator>Araki, Clifford T.</creator><creator>Goldberg, Mark C.</creator><creator>Jamil, Zafar</creator><creator>Padberg, Frank T.</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19971201</creationdate><title>Vein transposition in the forearm for autogenous hemodialysis access</title><author>Silva, Michael B. ; Hobson, Robert W. ; Pappas, Peter J. ; Haser, Paul B. ; Araki, Clifford T. ; Goldberg, Mark C. ; Jamil, Zafar ; Padberg, Frank T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-436f91d52db24b73b6b0f07637f263cc08d94a19bda2ffb26499de7fbd2dfef93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arteriovenous Shunt, Surgical - methods</topic><topic>Brachial Artery - surgery</topic><topic>Female</topic><topic>Forearm - blood supply</topic><topic>Forearm - surgery</topic><topic>Humans</topic><topic>Life Tables</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Radial Artery - surgery</topic><topic>Renal Dialysis</topic><topic>Treatment Outcome</topic><topic>Ulnar Artery - surgery</topic><topic>Veins - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silva, Michael B.</creatorcontrib><creatorcontrib>Hobson, Robert W.</creatorcontrib><creatorcontrib>Pappas, Peter J.</creatorcontrib><creatorcontrib>Haser, Paul B.</creatorcontrib><creatorcontrib>Araki, Clifford T.</creatorcontrib><creatorcontrib>Goldberg, Mark C.</creatorcontrib><creatorcontrib>Jamil, Zafar</creatorcontrib><creatorcontrib>Padberg, Frank T.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silva, Michael B.</au><au>Hobson, Robert W.</au><au>Pappas, Peter J.</au><au>Haser, Paul B.</au><au>Araki, Clifford T.</au><au>Goldberg, Mark C.</au><au>Jamil, Zafar</au><au>Padberg, Frank T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vein transposition in the forearm for autogenous hemodialysis access</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>1997-12-01</date><risdate>1997</risdate><volume>26</volume><issue>6</issue><spage>981</spage><epage>988</epage><pages>981-988</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Purpose: We describe a technique of superficial venous transposition in the forearm used for the formation of an arteriovenous fistula for hemodialysis access. These modifications of the single-incision radiocephalic fistula are designed to increase options for arteriovenous fistulas by using veins and arteries that are suitable for use but are not in immediate proximity.
Methods: Arteries and veins suitable for a primary arteriovenous fistula were identified and mapped using duplex ultrasound in 89 patients. Separate incisions were used in the majority of cases, and the selected forearm vein was mobilized, angiodilated, and transposed into a subcutaneous tunnel on the volar aspect of the forearm. Before initiation of hemodialysis, duplex ultrasound scanning was performed, and the location that was most suitable for cannulation was identified. Repeat scans were performed at 3-month intervals for analysis of patency.
Results: Superficial venous transpositions were performed using a single incision in 13 instances in which the vein was in immediate proximity to the radial artery (type A). Dorsal-to-volar forearm transposition (type B) was performed in 30 veins with anastomoses to the radial (n = 26), ulnar (n = 2), or brachial (n = 2) arteries. Volar-to-volar forearm transposition (type C) was performed in the remaining 46 veins, with anastomoses to the radial (n = 42), ulnar (n = 2), or brachial arteries (n = 2). Successful hemodialysis was accomplished in 81 of 89 patients (91%). The primary cumulative patency rate was 84% at 1 year and 69% at 2 years. The mean duration of follow-up was 14.3 months.
Conclusions: The use of superficial venous transposition for the formation of autogenous hemoaccess was associated with ease of cannulation by dialysis personnel, high maturation rates, reduced early failure rates, and enhanced patency rates. We recommend the use of these technical modifications to increase the use of autogenous fistulas in the forearm. (J Vasc Surg 1997;26:981-8.)</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>9423713</pmid><doi>10.1016/S0741-5214(97)70010-7</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of vascular surgery, 1997-12, Vol.26 (6), p.981-988 |
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| subjects | Adult Aged Aged, 80 and over Arteriovenous Shunt, Surgical - methods Brachial Artery - surgery Female Forearm - blood supply Forearm - surgery Humans Life Tables Male Middle Aged Radial Artery - surgery Renal Dialysis Treatment Outcome Ulnar Artery - surgery Veins - surgery |
| title | Vein transposition in the forearm for autogenous hemodialysis access |
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