Elbow Fistula Research Articles

The gracz arteriovenous fistula evaluated. Results of the brachiocephalic elbow fistula in haemodialysis angio-access

To assess fistula patency and complication rates in braciocephalic elbow fistulas of both the Gracz and the side-to-side configuration. Retrospective clinical study. Life table patency and complications of 50 Gracz fistulas and 23 side-to-side elbow fistulas created between 1988 and 1993 were reviewed. The cumulative patency for the elbow fistulas was 84% after 1 year and 78% after 3 years. No difference was found between the Gracz fistula and the side-to-side elbow fistula. Stenosis was the most frequent indication for revision and thrombosis was the most frequent cause of fistula failure. The elbow fistula has a long patency with few complications and performs as well as wrist fistulas and better than the graft fistulas reported in the literature. The Gracz elbow fistula has results as good as the side-to-side elbow fistula. Graft fistulas should be reserved for tertiary procedures only.

Microsurgery in gaining paediatric vascular access for haemodialysis.

One hundred and one surgical procedures performed in children for construction and maintenance of vascular accesses for haemodialysis were retrospectively analyzed. There were 86 operations performed to create a new fistula in patients without vascular access or with nonrecoverable failed angio-access. Fifteen surgical procedures were performed to treat fistula complications. The new fistulas were radiocephalic n = 60 (70%), ulnar-basilic n = 5 (5.8%), antecubital n = 9 (10.3%), and PTFE grafts n = 12 (14%). Microsurgical techniques were used in all cases, including PTFE graft fistulas. A microscope was used in 56 cases (55.4%) and magnifying loupes (x 2.5 magnification) in the rest of the operations. Early-failure rate for radiocephalic fistulas was 10%. Cumulative patency rates in radiocephalic fistulas were 79%, 75%, and 70% at 1, 2, and 5 years, respectively. No statistical differences were found from the cumulative patency curve of 730 radial-cephalic fistulas performed in adults during the same period of time. Radiocephalic fistulas can be constructed in most paediatric cases using microsurgical technique. Elbow fistulas can be the second-choice vascular access, and PTFE grafts can be reserved for children with exhaustion of autologous veins. Brachial-jugular PTFE grafts can be used in cases of subclavian vein stenosis.

Five years' experience in access surgery for polychemotherapy. An analysis of results in 100 consecutive patients.

In 100 consecutive patients with various malignancies, 142 operations were performed to establish an arteriovenous fistula giving vascular access for chemotherapy. The fistula of choice was always an end-to-side fistula between the cephalic vein and the radial artery (radiocephalic fistula). A fistula of this type was established in 88 operations on 76 patients and functioned well in 64% of this group. In 29 patients in whom this fistula failed or was not feasible, an elbow fistula was performed in 32 operations and functioning well in 59%. In 13 patients whose arms offered no alternative possibility, 15 long saphenous vein (LSV) autografts were implanted in the inguinal region. A radiocephalic fistula was successfully performed in 77% of the patients who had received preoperative chemotherapy during less than 4 weeks, versus 26% of those who had received preoperative chemotherapy during a longer period. The radiocephalic fistula is the fistula of choice to gain vascular access for chemotherapy. It has proved necessary to perform this operation before chemotherapy is started. When this type of fistula is not feasible, alternatives are an elbow fistula or an (LSV) autograft in the inguinal region.