The transposed forearm loop arteriovenous fistula: a valuable option for primary hemodialysis access in diabetic patients

Annals of Vascular Surgery
Jonathan Y GefenIra S Meisels

Abstract

The distal forearm is the site of first choice for creation of an arteriovenous fistula for hemodialysis. The archetypal procedure, the primary radial-cephalic fistula as described by Brescia, yields excellent functional patency for many patients. Results are much less favorable in patients with diabetes mellitus, for whom non-maturation rates as high as 70% have been reported. This is likely due to inadequate inflow caused by atherosclerotic disease of the forearm arteries in diabetics. Secondary autologous access procedures often involve upper arm configurations such as transposed brachial-basilic fistulas. The present study focuses on a valuable alternative for hemodialysis access in diabetic patients, the transposed forearm loop arteriovenous fistula. Over a 2-year period, 16 forearm loop fistulas were created in 16 diabetic patients who either had a failed radial-cephalic fistula or had arterial anatomy deemed inadequate for wrist fistula formation. In each case, the forearm segment of the basilic or cephalic vein was transposed to form a U-shaped loop and anastomosed to the brachial, proximal radial, or proximal ulnar artery distal to the antecubitai fossa. Functional patency was defined as usability for dialysis. Patency...Continue Reading

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Citations

Aug 5, 2011·Indian Journal of Urology : IJU : Journal of the Urological Society of India·Aneesh Srivastava, Sandeep Sharma
Mar 11, 2004·Seminars in Vascular Surgery·Jonathan M WeiswasserAnton N Sidawy
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
Nov 18, 2017·The Journal of Vascular Access·Weng Jun Tang, Arman Zaharil Mat Saad
Mar 29, 2018·The Journal of Vascular Access·Maciej ZielinskiGrzegorz Oszkinis
Aug 5, 2017·The Journal of Vascular Access·Ali Kordzadeh, Yiannis P Panayiotopolous
Jul 17, 2008·Seminars in Dialysis·Geoffrey C SlaydenWilliam C Jennings
Apr 9, 2010·Seminars in Dialysis·Alexander S Goldfarb-Rumyantzev, Preeti Rout
Feb 27, 2016·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·Yit-Sheung YapYi-Chun Liu
Apr 11, 2012·Hemodialysis International·Ranil N DeSilvaAlexander S Goldfarb-Rumyantzev
Sep 22, 2007·Seminars in Vascular Surgery·Alik Farber, Karen Woo
Jun 4, 2011·Current Problems in Surgery·Michael J CostanzaVivian Gahtan

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