Creating percutaneous radiocephalic arteriovenous fistulas at the wrist.
J Vasc Access
; 22(2): 299-303, 2021 Mar.
Article
en En
| MEDLINE
| ID: mdl-32597355
BACKGROUND: The first arteriovenous fistulas were created at the wrist more than 60 years ago. Basic surgical construction techniques remain unchanged with mobilization and repositioning of the vessels followed by a sutured anastomosis. We used the Ellipsys device to construct percutaneous radiocephalic-arteriovenous fistulas at the wrist and report the results. METHODS: Data were reviewed retrospectively for all patients who had a percutaneous radiocephalic-arteriovenous fistula created during a 6-month period. Each individual underwent ultrasound vessel mapping in addition to physical examination. When a radiocephalic-arteriovenous fistula was feasible and a communicating vein ⩾ 2 mm in diameter was noted in the distal forearm along with a radial artery ⩾ 2 mm, a percutaneous radiocephalic-arteriovenous fistula was considered and reviewed with the patient. RESULTS: Four individuals met the criteria to consider a percutaneous radiocephalic-arteriovenous fistula and all elected to have the procedure performed. Ages were 54-85 years. Three were diabetic and one was female. All percutaneous radiocephalic-arteriovenous fistulas were technically successful. Two individuals had not yet started dialysis therapy. Successful and repetitive cannulation for the two individuals with catheters was initiated at 4 and 8 weeks post procedure. The two pre-dialysis patients had physiologic arteriovenous fistula maturation (6 mm vein diameter and >500 mL/min flow) at 4 and 12 weeks. There were no procedural or late complications and none required intervention. Follow-up was 8-23 months (mean 16 months). CONCLUSION: The success of these percutaneous radiocephalic-arteriovenous fistulas suggests that use of the Ellipsys device will be applicable at the wrist in selected patients where appropriate vessel sizes and configurations are found.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Muñeca
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Derivación Arteriovenosa Quirúrgica
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Diálisis Renal
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Arteria Radial
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Implantación de Prótesis Vascular
Tipo de estudio:
Observational_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Vasc Access
Asunto de la revista:
ANGIOLOGIA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Francia
Pais de publicación:
Estados Unidos