Abstract: TH-PO773

Vein Grafting – A Novel Approach for Forearm Dialysis Arteriovenous Fistula Creation

Session Information

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
AgeGenderAVFGraftGraft LengthRadial Artery DiameterGraft DiameterNative Distal Vein Diameter6-week AVF Diameter6-week AVF Flow3-month AVF Diameter3-month AVF FlowComplications & Patency
65MaleRadiobasilicContralateral basilic vein5.5 cm2.2 mm2.2 mm<1.5 mm5.2 mm760 ml/min5.5 mm820 ml/minThrombosis at 4 months*, patent at 12 months
58MaleRadiobasilicContralateral basilic vein6.0 cm1.8 mm2.1 mm<1.5 mm5.0 mm710 ml/min5.0 mm730 ml/minPatent at 12 months
68MaleRadiobasilicContralateral basilic vein7.0 cm1.8 mm2.1 mm<1.5 mm4.6 mm521 ml/min4.8 mm627 ml/minPatent at 12 months
53MaleRadiobasilicContralateral basilic vein5.2 cm2.3 mm2.2 mm<1.5 mm5.2 mm628 ml/min5.4 mm783 ml/minPatent at 12 months
36MaleRadiobasilicContralateral basilic vein6.6 cm2.1 mm2.2 mm<1.5 mm5.2 mm651 ml/min5.3 mm784 ml/minPatent at 12 months
52MaleRadiobasilicGreat saphenous vein22 cm1.8 mm2.3 mm<1.5 mm5.3 mm748 ml/min5.3 mm768 ml/minPatent at 12 months
67MaleRadiocephalicGreat saphenous vein25 cm2.1 mm3.9 mm<1.5 mm5.0 mm772 ml/min5.0 mm782 ml/minPatent at 12 months

* status post angioplasty

Funding

  • Clinical Revenue Support