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Side-to-side arteriovenous fistula at the elbow with perforating vein ligation Majid Moini, MD, G. Melville Williams, MD, Mohammad Sadegh Pourabbasi, MD, Mohammad Reza Rasouli, Payam Tarighi, MD, Armita Mardanloo, MD, Hussein Rayatzadeh Journal of Vascular Surgery Volume 47, Issue 6, Pages 1274-1278 (June 2008) DOI: 10.1016/j.jvs.2007.11.075 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 These sketches illustrate in a left arm the areas of venous occlusion in the hemodynamic studies. The wrist is to the right. The radial artery pressure was measured after clamping: A, cephalic vein; B, basilic vein; C, perforating vein; and D, both basilic and perforating veins. Journal of Vascular Surgery 2008 47, 1274-1278DOI: (10.1016/j.jvs.2007.11.075) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 This is an operative photograph showing the location of the incision on the left arm and the early venous dissection. The wrist is to the right. Note the small size of the incision which was possible in this thin arm. When the veins and artery are deeper or when the cephalic vein is used for the anastomosis, the incision must be larger or made transversely. The perforating vein is found by dissecting the confluence of the medial antecubital vein, running medially (to the bottom of the photograph), and the cephalic vein running superiorly. The perforating vein is marked x. Journal of Vascular Surgery 2008 47, 1274-1278DOI: (10.1016/j.jvs.2007.11.075) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 This operative photograph shows the size of the venotomy and arteriotomy. The brachial artery, which is toward the bottom of the figure, is readily accessible in this patient. The perforating vein has been ligated. The side-to-side anastomosis is accomplished with a simple running 6-0 polypropylene suture. Journal of Vascular Surgery 2008 47, 1274-1278DOI: (10.1016/j.jvs.2007.11.075) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 The vertical lines represent the changes in mean radial artery pressure before and after occlusion of the perforating vein. Note that, with one exception, there was a significant increase in radial artery pressure following occlusion of the perforating vein. Journal of Vascular Surgery 2008 47, 1274-1278DOI: (10.1016/j.jvs.2007.11.075) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 Primary access functional success over time by life table analysis. Note that 90% of patients were dialyzed successfully at 12 months and 84% at 2 years without the need for revision. Journal of Vascular Surgery 2008 47, 1274-1278DOI: (10.1016/j.jvs.2007.11.075) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions