Abstract
The autogenous brachiocephalic or brachiobasilic arteriovenous elbow fistula is not considered to be only the secondary haemodialysis access. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fistula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia. To summarise current knowledge of this fistula type and its associated complications Review of the literature. The creation and maturation of the fistula and occurrence of the steal syndrome is influenced by a number of factors. The analysis and awareness of such factors will provide for creation of a suitable fistula as well as for timely complication diagnostics and treatment. The autogenous elbow fistula utilising the brachial artery and the cephalic or basilic vein in the upper extremity represents a high-quality haemodialysis access. Its potential complication is the occurrence of the steal syndrome. Its occurrence and manifestations do not constitute indications for ligation of the access. The gathered information shows that a suitable surgical procedure can help meet the basic rule for haemodialysis access--resolving the ischemia and maintaining the access.
Highlights
METHODSThe creation of a quality arteriovenous (AV) fistula for haemodialysis is dependent on a relatively healthy and undamaged arterial and subcutaneous venous bed
Polymorbid patients are dialysed with lower quality distal forearm vascular bundle, unsuitable for AV fistula creation, and elbow fistula becomes the primary access
Use of the perforating vein for anastomosis was published by Gracz5. 10–25 % of cases of the brachiocephalic and brachiobasilic AV fistulas show steal syndrome presentations
Summary
The creation of a quality arteriovenous (AV) fistula for haemodialysis is dependent on a relatively healthy and undamaged arterial and subcutaneous venous bed. The autogenous AV fistula in elbow, which utilises the rich subcutaneous venous bed, is mainly considered the “secondary” access after having exhausted all the possibilities of fistula creation at the more distal level[2]. Polymorbid patients are dialysed with lower quality distal forearm vascular bundle, unsuitable for AV fistula creation, and elbow fistula becomes the primary access. In 1970 Cascardo et al.[3] published their experience in creating elbow AV fistulas for low-quality forearm arterial bed. In patients with an unsuitable forearm vessel bundle, it is indicated as primary access and it is the method preferred to the fistula creation using a vascular prosthesis. Its rather rare complication is the development of upper extremity ischemia
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