Evaluation of brachial artery, brachial vena commitante fistula : as an autogenous option for hemodialysis access

Abstract EN

Background / Aim : the optimal dialysis access for patients with end-stage chronic renal disease is considered to be an autogenously arteriovenous fistula (AVF).

In this case series we describe our experience with an autogenously fistula created using one of the venae commit antes of the brachial artery, evaluating its technical aspects, efficacy and complications.

Patients and Methods : from January 2002 until February 2005, 32 patients were operated on for dialysis access.

All patients had no adequate superficial veins either by clinical examination or by ultrasound study.

Ultrasound mapping of the basilica vein was done for all cases, suggesting an adequate vein (i.e.

diameter > 2mm).

On exploration of the basilica vein it was found to be non-suitable for creation of a fistula.

Instead of using a prosthetic graft, we preceded with the dissection of one of the venae commit antes of the brachial artery and created brachial artery-brachial vena Commit ante fistula.

Follow up of the cases for one year was done to scrutinize the fistula for patency and complications.

Results : 32 fistulas were done in 32 patients.

There were 18 females and 14 males, with mean age of 42.56 year (range 17-62 year).

25 patients were diabetic.

The mean operative time was 85 minutes.

Primary failure occurred in 3 cases (3 / 32, 9.3 %).

Postoperative complications included: massive bleeding in one case (1 / 32, 3.1 %), wound infection in 2 cases (2 / 32, 6.2 %) edema of the hand and forearm in 2 cases (2 32, 6.2 %) and lymphorrhea in one case (1 / 32, 3.1 %).

4 cases lost follow up.

Remote complications included: thrombosis in 2 cases (2 / 25, 8 %) and vein aneurysm in one case (1 / 25, 4 %).

One year patency rate was 23 / 25 (92 %) after exclusion of cases of primary failure and cases lost follow up.

Conclusion : the brachial artery-brachial vena Commit ante fistula could be a feasible option for hemodialysis access in patients with no adequate superficial veins and when the basilicas vein is not suitable for creation of fistula before resorting to prosthetic graft.