Bradley B. Hill, MD, A. K. Chan, MD, R. M. Faruqi, MD, F. R

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Presentation transcript:

Keyhole technique for autologous brachiobasilic transposition arteriovenous fistula Bradley B. Hill, MD, A.K. Chan, MD, R.M. Faruqi, MD, F.R. Arko, MD, C.K. Zarins, MD, T.J. Fogarty, MD Journal of Vascular Surgery Volume 42, Issue 5, Pages 945-950 (November 2005) DOI: 10.1016/j.jvs.2005.07.013 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 The basilic vein is mobilized and divided distal to the elbow crease. A straight stiff Glidewire is inserted through the open proximal end of the vein and advanced until the tip of the catheter is approximately in the superior vena cava. The vein extraction catheter is advanced over the wire, and the vein is suture-ligated to the catheter as shown. Journal of Vascular Surgery 2005 42, 945-950DOI: (10.1016/j.jvs.2005.07.013) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 Steady force on the catheter in a cephalad direction (arrow) while gently grasping the vein near the suture ligature begins the inversion process. Journal of Vascular Surgery 2005 42, 945-950DOI: (10.1016/j.jvs.2005.07.013) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 The fully mobilized vein is shown exiting the axillary incision. The catheter is used to infuse heparin-saline solution for preparing the vein and for pulling the vein through the tunneling device. Journal of Vascular Surgery 2005 42, 945-950DOI: (10.1016/j.jvs.2005.07.013) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 4 Tunneling through a superficial plane is accomplished with local anesthesia. Journal of Vascular Surgery 2005 42, 945-950DOI: (10.1016/j.jvs.2005.07.013) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 5 The newly functioning brachiobasilic arteriovenous fistula courses along the anterior aspect of the upper arm. Journal of Vascular Surgery 2005 42, 945-950DOI: (10.1016/j.jvs.2005.07.013) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 6 Life table comparing primary-patency results for arteriovenous (AV) fistulas created by using veins with diameters of 4 mm or more (dashed line) and less than 4 mm (solid line). The difference in patency at 8 months (80% for veins ≥4 mm and 50% for veins <4 mm) did not reach statistical significance (P = .74). Journal of Vascular Surgery 2005 42, 945-950DOI: (10.1016/j.jvs.2005.07.013) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions