The two-stage brachial artery-brachial vein autogenous fistula for hemodialysis: an alternative autogenous option for hemodialysis access.

The optimal dialysis access for the patient with chronic renal failure is considered to be an autogenous fistula; this is reflected in the recommendations of the National Kidney Foundation-Disease Outcomes Quality Initiatives (NKF-DOQI). If adequate superficial veins at the wrist or the forearm are not available, the next option is usually a prosthetic arteriovenous graft. In this case series, we describe our experience with an autogenous fistula constructed using the brachial vein. There were 20 patients over a 14-month period who were operated on for dialysis access. In these patients, no adequate superficial veins were found at operation. Instead of using a prosthetic graft, we performed a brachial artery-brachial vein fistula in two stages. The first stage involved a forearm anastomosis and then subsequently, weeks later, this fistula was "superficialized." Twenty patients underwent a brachial artery-brachial vein fistula. Of these patients, all had successful maturation of their fistula and after a minimum waiting period of 12 weeks for maturation; all but one were able to be successfully dialyzed through their fistula. One patient developed arm swelling due to previously placed subclavian vein pacemaker wires. None of the other patients developed arm swelling or vascular steal. The brachial artery-brachial vein fistula is a feasible option for hemodialysis access and we suggest that this option be considered before a prosthetic arteriovenous graft is inserted. Arm swelling and steal have not been a problem, and all patients have been able to have full dialysis through the fistula after appropriate maturation times.