Abstract
INTRODUCTION: The distal part of the forearm is preferred for hemodialysis access during arteriovenous (AV) fistula reconstruction. However, the small diameter of the forearm vessel leads to complications such as obstruction, which have resulted in a mean patency rate of 65.2% (range: 56–79%) in the first year after surgery.1 In this study, Brescia-Cimino AV fistula reconstruction for hemodialysis access was performed using microscope, and the patency rate was determined. METHODS: Six patients with chronic renal failure (CRF) were included in this retrospective study. From 2014 to 2015, the patients received Brescia-Cimino AV fistula reconstruction. A vein diameter of >2 mm at wrist level was confirmed by pre-operative venogram, and Doppler mapping was performed. Microanastomosis of the AV fistula was performed in an end-to-side suture pattern with Nylon #9-0. One month after surgery, vessel obstruction and blood flow were monitored by venogram and portable Doppler. The mean patency rate was obtained by the Kaplan-Meier method. RESULTS: Five out of the six patients received hemodialysis without signs of obstruction or complications; thus, the mean patency rate is 83.3%. One female patient underwent percutaneous transluminal angioplasty (PTA) before and after AV fistula operation due to vessel obstruction. The mean follow-up period was eight months (range: 5–12 months). CONCLUSION: For relatively healthy vessels with diameter of >2 mm, AV fistula reconstruction (Brescia-Cimino) by fine microsurgical suturing under a microscope can be safely done at the wrist without complications such as ischemic hand syndrome or infection. Reference Citations: 1. Al-Jaishi, A. A., Oliver, M. J., Thomas, S. M., et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. American journal of kidney diseases: the official journal of the National Kidney Foundation2014;63:464–478.
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