Radio–median cubital / radiocephalic arteriovenous fistula at elbow to prevent vascular steal syndrome associated with brachiocephalic fistula: Review of 210 cases

Dr. Amarapilli Appalaraju; Dr. D. Hari Prasad; Dr. Vanajakshi.Jami

Volume : VIII, Issue : IV, April - 2019

Radio–median cubital / radiocephalic arteriovenous fistula at elbow to prevent vascular steal syndrome associated with brachiocephalic fistula: Review of 210 cases

Dr. Amarapilli Appalaraju, Dr. D. Hari Prasad, Dr. Vanajakshi. Jami

Abstract :

Aim: Radiocephalic arteriovenous fistula (AVF) at wrist is the vascular access of choice for dialysis. In the absence of a suitable vein at the wrist, a achiocephalic fistula at elbow is usually constructed. In order to avoid the complication of vascular steal syndrome associated with the achiocephalic fistula, an alternative operative technique involving the creation of radio–median cubital vein / radiocephalic fistula at elbow was evaluated. . Materials and Methods: we Retrospective study Between june 2016 to june 2018, 210 patients underwent creation of radio–median cubital vein / radiocephalic AVF at elbow as a primary procedure or following failure of a fistula at the wrist. A transverse skin incision was made 4cm below the elbow crease, centering in line with the achial artery pulsation. The median cubital vein / cephalic vein was anastomosed to the radial artery in end to side fashion. The surgical complications and patency of the fistulae were analyzed in the immediate and late postoperative period. Results: Mean operative time was52 min( 45to60). There were no major intraoperative complications. Immediate patency and a palpable distal radial pulse were present in all the patients. Mean time to fistula maturation was 35days(25to45). No patient developed a vascular steal syndrome at a follow–up of 24 months . Early fistula failure was seen in 9 (4.28%) patients whereas four (1.9%) fistulas failed at a later date. Pseudoaneurysm of the arterialized vein at the fistula site developed in only one (0.3%) patient. Conclusions: The radio–median cubital vein / radiocephalic AV fistula at elbow is safe and is a better vascular access procedure for hemodialysis than achiocephalic fistula because it leads to the dilatation of both the cephalic and the basilic veins with no incidence of vascular steal phenomenon in our experience. Patency and flow rates are similar to achiocephalic fistula