The fistula elevation procedure: a valuable technique for maximizing arteriovenous fistula utilization

Annals of Vascular Surgery
David L CullEugene M Langan

Abstract

Many patients are not considered candidates for radiocephalic fistula (RCF) or brachiocephalic fistula (BCF) creation or have fistulas that do not mature because the cephalic vein is too deep or tortuous to be accessed. Other patients have not been candidates for the basilic vein transposition (BVT) because limited length of adequate caliber vein precludes subcutaneous tunneling of the vein. In an effort to maximize arteriovenous fistula (AVF) utilization, we developed an adjunctive procedure designed to make the deep or tortuous fistula accessible to needle cannulation. The fistula elevation procedure (FEP) involves mobilization of the fistula, approximation of the subcutaneous tissue beneath the fistula, and subcuticular skin closure over the fistula. The procedure enhances the accessibility of the fistula by placing it in a more superficial position. The overlying cicatrix also acts as a guide for dialysis needle insertion. Between June 1998 and January 2001, 45 patients underwent a natural AVF that could not be accessed secondary to venous depth, tortuosity, or length. In each case, a FEP was performed to salvage the fistula. The FEP was performed as an adjunct to a BCF in 20 patients, a RCF in 7 patients, and a BVT in 8 pa...Continue Reading

Citations

Jul 13, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Karen Woo, Charmaine E Lok
Nov 22, 2005·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·J H M TordoirF M van der Sande
Mar 10, 2016·The Journal of Vascular Access·Surendra ShenoySarah Matson
May 29, 2018·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Andrej IsaakLorenz Gürke
May 20, 2003·Seminars in Dialysis·Charmaine E Lok, Matthew J Oliver
Mar 8, 2013·Journal of Renal Care·Annemarie Verhallen
Mar 2, 2011·The Canadian Journal of Plastic Surgery = Journal Canadien De Chirurgie Plastique·Daniel J KrochmalAnthony A Smith
Dec 19, 2003·Journal of Vascular Surgery·Hung Michael ChoiPeter J Pappas
Sep 22, 2007·Seminars in Vascular Surgery·Alik Farber, Karen Woo
Dec 15, 2010·American Journal of Surgery·Kayla J BarnardWilliam C Jennings

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