The Radiobasilic Transposition on the Upper Arm

Year 2017, Volume: 22 Issue: 1, 16 - 23, 30.12.2016

Okay Güven Karaca Mehmet Ali Sungur Ayşegül Koç

https://doi.org/10.21673/anadoluklin.284863

Abstract

Amaç: Hemodiyaliz için ideal giriş yolu üst ekstremitede distalden proksimale doğru olan otolog arteryovenöz fistüllerdir. Brakiyal arteri giriş arteri olarak kullanmak, özellikle steal sendromu olmak üzere komplikasyon riskini attırır. Bu çalışmada üst ekstremitede radyal arterden orijin alan radyobazilik ven transpozisyonu tekniği ile yaptığımız arteryovenöz fistüllerin sonuçlarını açıklamayı amaçladık.

Gereç ve Yöntemler: Bu retrospektif çalışma, Ocak 2009 – Aralık 2012 döneminde radyobazilik transpozisyon arteryovenöz fistül yaptığımız kırk hastayı kapsamaktadır. Steal sendromu, venöz hipertansiyon ve anevrizma gibi postoperatif komplikasyonlar kaydedildi. 

Bulgular: Takip süresince üç hastada anevrizma gelişti. Hastaların hiçbirinde steal sendromu ve venöz hipertansiyon görülmedi. Ortalama takip süresi 28,99±1,57 ay idi. Bir yıllık ve iki yıllık primer açık kalma oranları sırası ile %76,6 ve %49,5 idi. Bir yıllık ve iki yıllık sekonder açık kalma oranları ise sırası ile %81,4 ve %55,6 idi. 

Tartışma ve Sonuç: Steal sendromu brakiyal arterden orijin alan arteryovenöz fistüllerde radyal arterden orijin alan arteryovenöz fistüllere göre daha fazla görülür. Pek çok araştırmacı komplikasyonlardan kaçınmak için giriş arteri olarak proksimal radyal arteri kullanılmıştır. Sonuçta özellikle RBAVF şeklinde yapılan bazilik ven transpozisyonunun steal sendromu açısından daha güvenli olduğunu ve patensi oranlarının da literatür ile uyumlu olduğunu düşünüyoruz. Bununla birlikte karşılaştırmalı çalışmaların gerektiğine inanıyoruz

Keywords

arteryovenöz fistül, hemodiyaliz, bazilik ven transpozisyonu

The Radiobasilic Transposition on the Upper Arm

Abstract

Aim: The ideal vascular access for hemodialysis is through autologous arteriovenous fistulas that are from the distal to the proximal in the upper extremity. Using the brachial artery as the inflow artery increases the risk of developing complications, especially steal syndrome. In this study we aimed to explain the results of the arteriovenous fistulas that we performed with the technique of radiobasilic vein transposition that originated from the radial artery in the upper arm. 

Materials and Methods: Forty patients who had undergone radio-basilic transposition arteriovenous fistula operation between January 2009 and December 2012 were included in this retrospectively study. The recorded postoperative complications included steal syndrome, venous hypertension, and aneurysm. 

Results: In the follow-up period three patients developed aneurism. Steal syndrome and enous hypertension were observed in none of the patients. The mean follow-up duration was 28.99±1.57 months. The one-year and two-year primary (and secondary) patency rates were 76.6% and 49.5% (and 81.4% and 55.6%), respectively. 

Discussion and Conclusion: Steal syndrome is more frequently observed in arteriovenous fistulas that originate from brachial artery than from radial artery. Many researchers used the proximal radial artery as the inflow artery in order to avoid complications. We conclude that basilic vein transposition is safer against steal syndrome especially when performed as radiobasilic transposition arteriovenous fistula, and that the patency rates are coherent with the literature. However, we believe that comparative studies are needed

Keywords

arteriovenous fistula, hemodialysis, basilic vein transposition

References

• 1. Clinical practice guidelines for vascular access. Vascular Access Workgroup. (National Kidney Foundation’s KDOQI 2006 Vascular Access Guidelines). Am J Kidney Dis. 2006:48:227–350.
• 2. Sidawy AN, Spergel LM, Besarab A, et al. The Societynfor Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg. 2008;48:2–25.
• 3. Fistula First: National Vascular Access Improvement Initiative. [Revised 2009; cited 18 December 2010]. Available at: http://www.fistulafirst.org/. Accessed 1 June 2010.
• 4. Tordoir JHM, Dammers R, van der Sande FM. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg. 2004;27:1–5.
• 5. Matolo N, Kastagir B, Stevens LE, et al. Neurovascular complications of brachial arteriovenous fistula. Am J Surg. 1971;121:716–9
• .6. Lazarides MK, Staramos DN, Panagopoulos GN, et al. Indications for surgical treatment of angioaccess-induced arterial “steal.” J Am Coll Surg. 1998;187:422–6.
• 7. Cascardo S, Acchiardo S, Beven EG, et al. Proximal arteriovenous fistulae for hemodialysis when radial arteries are unavailable. Proc Eur Dial Transplant Assoc. 1970;7:42–6.
• 8. Dagher F, Gelber R, Ramos E, et al. The use of basilic vein and brachial artery as an A-V fistula for long term hemodialysis. J Surg Res. 1976;20:373–6.
• 9. Tordoir JH, Keuter X, Planken N, et al. Autogenous options in secondary and tertiary access for haemodialysis.Eur J Vasc Endovasc Surg. 2006;31:661–6.
• 10. Hill BB, Chan AK, Faruqi RM, et al. Keyhole technique for autologous brachiobasilic transposition arteriovenous fistula. J Vasc Surg. 2005;42:945–50.
• 11. Tordoir JH, Dammers R, de Brauw M. Video-assisted basilic vein transposition for haemodialysis vascular access: preliminary experience with a new technique Nephrol Dial Transplant. 2001;16:391–4.
• 12. Kakkos SK, Haddad GK. Two-stage combined basilicbrachial vein transposition. Vascular. 2009;17:96–9.
• 13. Hastaoglu IO, Bilgen F. Basilic vein transposition performed for hemodialysis access: mid-term results [in Turkish]. Turkish J Thorac Cardiovasc Surg.2011;19(4):513–7.
• 14. Ehsan O, Bhattacharya D, Darwish A, et al. ‘Extension technique’: a modified technique for brachio-cephalic fistula to prevent dialysis access-associated steal syndrome. Eur J Vasc Endovasc Surg. 2005;29:324–7.
• 15. Wu CC, Jiang H, Cheng J, et al. The outcome of the proximal radial artery arteriovenous fistula. J Vasc Surg. 2015;61:802–8.
• 16. Sidawy AN, Gray R, Resarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis
• 17. Quinton W, Dillard D, Scribner BH. Cannulation of blood vessels for prolonged haemodialysis. Trans Am Soc Artif Intern Organs. 1960;6:104–13.
• 18. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic haemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966;275:1089–92.
• 19. Salahi H, Fazelzadeh A, Mehdizadeh A, et al. Complications of arteriovenous fistula in dialysis patients. Transplant
• 20. Kaiser CL, Anaya-Ayala JE, Ismail N, et al. Unrecognized basilic vein variation leading to complication during basilic vein transposition arteriovenous fistula creation: case report and implications for access planning. Eur J Vasc Endovasc Surg. 2010;39:627–9.
• 21. Anaya-Ayala JE, Younes HK, Kaiser KL, et al. Prevalence of variant brachial-basilic vein anatomy and implications
• 22. Scali ST, Huber TS. Treatment strategies for access-related hand ischemia. Semin Vasc Surg. 2011;24:128–36.
• 23. Papasavas PK, Reifsnyder T, Birdas TJ, et al. Prediction of arteriovenous access steal syndrome utilizing digital pressure measurements. Vasc Endovascular Surg. 2003;37:179–84.
• 24. Tan TW, Farber A. Brachial-basilic autogenous access. Sem Vasc Surg. 2011;24:63–71.