Superficialization of the outflow vein in case of a cubital fistula - always or sometimes?

Abstract

The hemodialysis treatment requires an outflow vein from an arterio-venous fistula which is easily accessible and suitable for multiple venepunctures. The growing number of elderly patients, overweight ones and such with diabetes mellitus has been leading to increased relative share of the primary cubital anastomoses. The data set comprises of 442 arterio-venous anastomoses performed within a 5-year period (from 1st July 2011 until 30th June 2016) in the Clinic of Nephrology and Dialysis at Medical University, Pleven, Bulgaria. The primary cubital fistulas are 311 (70 %) of all cases. Consecutive superficialization of the outflow vein is performed in 18 cases (6 %). Not a single case of complications has been recorded - neither during the intervention, nor during the usage of the fistula afterwards. One-year patency of the fistula is observed in 17 patients (94 %). The surgery has been successful (comfortable access for puncture area) in 17 cases (94 %). Our experience demonstrates that the planned superficialization of the outflow vein(s) is beneficial and highly advisable. The latter improves the hospital treatment quality of the hemodialysis patients.