Abstract: TH-PO773
Vein Grafting – A Novel Approach for Forearm Dialysis Arteriovenous Fistula Creation
Session Information
- Hemodialysis: Vascular Access - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Chen, Jian, Brown University, Providence, Rhode Island, United States
- Tang, Jie, Brown University, Providence, Rhode Island, United States
Background
With the growing need for reliable and durable forearm hemodialysis access, here we describe a novel “autologous vein grafting” technique for the creation of forearm arteriovenous fistula (AVF).
Methods
All study participants failed to have native distal cephalic or basilic veins large enough for forearm AVF creation. Therefore, we harvested a segment of contralateral forearm mid-basilic vein or leg great saphenous vein from the same patient, and performed an end-to-side anastomosis to the radial artery and an end-to-end anastomosis to the mid-cephalic or basilic vein to create a forearm AVF. We identified patients who underwent this procedure between January 2014 and January 2016, and report measurements of fistula diameter (at 1 cm from the arterial anastomosis) and doppler flow at 6 weeks and 3 months after surgery, as well as 1-year primary unassisted patency, cumulative patency, and complications.
Results
We identified a total of 7 study participants. 6 underwent surgeries for radiobasilic AVF and 1 for radiocephalic AVF. Among the 6 who had radiobasilic AVF, 5 used contralateral forearm basilic vein segments, 1 used great saphenous vein segment. The one with the radiocephalic AVF used great saphenous vein. The diameters of their native forearm distal cephalic or basilic veins were <1.5mm, and the mean diameter of harvested vein graft segments was 2.4 mm (range 2.1-3.9 mm). 6 weeks after surgery, the mean diameter of AVF was 5.1 mm (range 4.6-5.3 mm), the mean fistula flow was 684 ml/min (range 521-772 ml/min). 3 months after surgery, the mean diameter of AVF was 5.2 mm (range 4.8-5.5 mm), the mean fistula flow was 756 ml/min (range 627-820 ml/min). The 1-year primary unassisted patency was 86%, and cumulative patency was 100%. There have been no complications reported.
Conclusion
Autologous vein grafting appeared to be an effective way to create a forearm AVF.
Vascular Characteristics of Study Participants
| Age | Gender | AVF | Graft | Graft Length | Radial Artery Diameter | Graft Diameter | Native Distal Vein Diameter | 6-week AVF Diameter | 6-week AVF Flow | 3-month AVF Diameter | 3-month AVF Flow | Complications & Patency |
| 65 | Male | Radiobasilic | Contralateral basilic vein | 5.5 cm | 2.2 mm | 2.2 mm | <1.5 mm | 5.2 mm | 760 ml/min | 5.5 mm | 820 ml/min | Thrombosis at 4 months*, patent at 12 months |
| 58 | Male | Radiobasilic | Contralateral basilic vein | 6.0 cm | 1.8 mm | 2.1 mm | <1.5 mm | 5.0 mm | 710 ml/min | 5.0 mm | 730 ml/min | Patent at 12 months |
| 68 | Male | Radiobasilic | Contralateral basilic vein | 7.0 cm | 1.8 mm | 2.1 mm | <1.5 mm | 4.6 mm | 521 ml/min | 4.8 mm | 627 ml/min | Patent at 12 months |
| 53 | Male | Radiobasilic | Contralateral basilic vein | 5.2 cm | 2.3 mm | 2.2 mm | <1.5 mm | 5.2 mm | 628 ml/min | 5.4 mm | 783 ml/min | Patent at 12 months |
| 36 | Male | Radiobasilic | Contralateral basilic vein | 6.6 cm | 2.1 mm | 2.2 mm | <1.5 mm | 5.2 mm | 651 ml/min | 5.3 mm | 784 ml/min | Patent at 12 months |
| 52 | Male | Radiobasilic | Great saphenous vein | 22 cm | 1.8 mm | 2.3 mm | <1.5 mm | 5.3 mm | 748 ml/min | 5.3 mm | 768 ml/min | Patent at 12 months |
| 67 | Male | Radiocephalic | Great saphenous vein | 25 cm | 2.1 mm | 3.9 mm | <1.5 mm | 5.0 mm | 772 ml/min | 5.0 mm | 782 ml/min | Patent at 12 months |
* status post angioplasty
Funding
- Clinical Revenue Support