Takashi Nakamura, MD, Kotaro Suemitsu, MD, Junichi Nakamura, MD

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Superficialization of brachial artery as effective alternative vascular access Takashi Nakamura, MD, Kotaro Suemitsu, MD, Junichi Nakamura, MD Journal of Vascular Surgery Volume 59, Issue 5, Pages 1385-1392 (May 2014) DOI: 10.1016/j.jvs.2013.11.093 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Details of the procedure. A, Hockey stick-shaped skin incision. B, Creation of skin flap. C, The brachial artery (BA) is isolated from its branches and subcutaneous tissue beneath the BA is sutured for superficialization. D, The skin flap is closed with interrupted sutures. Journal of Vascular Surgery 2014 59, 1385-1392DOI: (10.1016/j.jvs.2013.11.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Representative duplex ultrasound image of a superficialized brachial artery (BA) obtained 3 months after the procedure showing appropriate subcutaneous tissue thickness. Journal of Vascular Surgery 2014 59, 1385-1392DOI: (10.1016/j.jvs.2013.11.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Cannulation system (16 G). A, Metallic needle encased in a catheter with side holes. B, Magnified view of catheter tip. Note the side holes to enable efficient blood drawing. Journal of Vascular Surgery 2014 59, 1385-1392DOI: (10.1016/j.jvs.2013.11.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Representative views of superficialized brachial artery (BA) in use. A, The returning vein is the cephalic vein in the right upper arm. Modest aneurysmal changes of the superficialized BA can be seen. B, Both the vein and artery were cannulated with a 16-G needle (flow rate, 250 mL/minute; venous pressure, 100 mm Hg). This vascular access (VA) remained functioning for more than 4 years. C, No superficial veins were available and only the cephalic vein at the shoulder was used as a returning vein. D, Magnified view of returning vein (17-G needle; flow rate, 200 mL/minute; venous pressure, 100 mm Hg). E, Magnified view of superficialized BA. Modest aneurysmal changes were seen after 3 years of repeated cannulation (17-G needle; flow rate, 200 mL/minute). Journal of Vascular Surgery 2014 59, 1385-1392DOI: (10.1016/j.jvs.2013.11.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 Cumulative functional vascular access (VA) patency rate for 24 superficialized brachial arteries (BAs) in the present study. *Standard error exceeded 10% at 20 months. Journal of Vascular Surgery 2014 59, 1385-1392DOI: (10.1016/j.jvs.2013.11.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Cumulative survival rate for the 24 patients. *Standard error exceeded 10% at 16 months. Journal of Vascular Surgery 2014 59, 1385-1392DOI: (10.1016/j.jvs.2013.11.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions