Elamurugan E, Hemachandar R
Department of Cardiothoracic and Vascular Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidayapeeth University, Puducherry, India.
Department of Nephrology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidayapeeth University, Puducherry, India.
Indian J Nephrol. 2017 May-Jun;27(3):177-180. doi: 10.4103/0971-4065.179333.
In patients unsuitable for radiocephalic fistula creation, the next option is brachiocephalic fistula. In such patients, we exploited the venous interconnections in the cubital fossa for median cubital vein-Brachiocephalic arteriovenous fistula (AVF) creation. In this article, we describe our experience in the creation of such technical variant of the brachiocephalic fistula AVF, its success and associated complications. A retrospective review of such AVF created between September 2014 and August 2015 was done. The data collected included demographics, co-morbidities, basic disease, operative details, patency, complications, and mortality. A total of 68 vascular access surgeries were done which included 26 (38.2%) brachiocephalic AVF using the median antecubital vein. The mean cephalic vein diameter and mean flow rate were 7.18 mm and 1415 ml/min, respectively 2 months after fistula creation. The primary and secondary failure rates were 3.87% and 7.69% respectively. Complications included aneurysm (7.69%), edema (19.23%), hematoma (11.53%), and wound infection (3.8%). Using reverse flow in the median antecubital vein is a safe and simple way to perform brachiocephalic AVF before brachiobasilic AVF and grafts.
对于不适合建立桡动脉-头静脉内瘘的患者，下一个选择是肱动脉-头静脉内瘘。在此类患者中，我们利用肘窝处的静脉连接来建立贵要静脉-肱动脉-头静脉动静脉内瘘（AVF）。在本文中，我们描述了建立这种肱动脉-头静脉内瘘技术变体的经验、其成功率及相关并发症。对2014年9月至2015年8月期间建立的此类AVF进行了回顾性研究。收集的数据包括人口统计学资料、合并症、基础疾病、手术细节、通畅情况、并发症及死亡率。共进行了68例血管通路手术，其中包括26例（38.2%）使用肘正中静脉的肱动脉-头静脉AVF。内瘘建立2个月后，头静脉平均直径和平均血流量分别为7.18mm和1415ml/min。原发性和继发性失败率分别为3.87%和7.69%。并发症包括动脉瘤（7.69%）、水肿（19.23%）、血肿（11.53%）和伤口感染（3.8%）。在肱动脉-尺侧静脉AVF和移植物之前，利用肘正中静脉的逆流来进行肱动脉-头静脉AVF是一种安全且简单的方法。
