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December 23, 2005
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Stanislaw I. Przywara, MD, PhD, Jacek Wronski, MD, PhD, Ass. Prof., Piotr Terlecki, MD, PhD, Tomasz Zubilewicz, MD, PhD, Ass. Prof., Marcin Feldo, MD, PhD, Anna Bednarek-Skublewska, MD, PhD.
University School of Medicine, Lublin, Poland, Lublin, Poland.
OBJECTIVES: We present 3 cases of two-staged anterotransposition of brachial vein to be considered as the last option for native vascular access for hemodiaysis before forearm / upper arm graft placement.
METHODS: 3 patients with chronic renal insufficiency were admitted for the creation of vascular access for hemodialysis. Physical examination, confirmed by ultrasonography, revealed the absence of adequate cephalic and basilic veins. In each case, precise color Doppler ultrasound examination showed brachial artery with appropriate diameter and 2 wide, brachial veins joining into one axillary vein in the axillary fossa. Surgery was performed in 2 stages. During 1st stage of operation one of brachial veins was anastomosed with brachial artery end to side in the cubital fossa. The fistula was left for 4 weeks to mature, with the brachial vein in its anatomical location. During the 2nd stage entire length of brachial vein was exposed via one longitudinal incision from cubital fossa up to armpit. Mobilized vein was transposed subcutaneously to anterior location.
RESULTS: At present, 8 to 20 months after the procedure, venous pressures are within accepted ranges and hemodialysis is adequate.
CONCLUSIONS: Our technical report confirms that brachial vein can be utilized as the last option for creation of native vascular access on the upper arm. We recommend to perform the surgery in two separate stages. Maturation of the vein in its anatomical location between the 1st and 2nd stage of surgery assures proper dilatation and thickening of the vein which easier resists an extensive dissection and transposition during the 2nd stage.
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Two Staged Anterotransposition of Brachial Vein as the New Option for Native Vascular Access for Hemodialysis, Technical Report of 3 Cases
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Stanislaw I. Przywara, MD, PhD, Jacek Wronski, MD, PhD, Ass. Prof., Piotr Terlecki, MD, PhD, Tomasz Zubilewicz, MD, PhD, Ass. Prof., Marcin Feldo, MD, PhD, Anna Bednarek-Skublewska, MD, PhD.
University School of Medicine, Lublin, Poland, Lublin, Poland.
OBJECTIVES: We present 3 cases of two-staged anterotransposition of brachial vein to be considered as the last option for native vascular access for hemodiaysis before forearm / upper arm graft placement.
METHODS: 3 patients with chronic renal insufficiency were admitted for the creation of vascular access for hemodialysis. Physical examination, confirmed by ultrasonography, revealed the absence of adequate cephalic and basilic veins. In each case, precise color Doppler ultrasound examination showed brachial artery with appropriate diameter and 2 wide, brachial veins joining into one axillary vein in the axillary fossa. Surgery was performed in 2 stages. During 1st stage of operation one of brachial veins was anastomosed with brachial artery end to side in the cubital fossa. The fistula was left for 4 weeks to mature, with the brachial vein in its anatomical location. During the 2nd stage entire length of brachial vein was exposed via one longitudinal incision from cubital fossa up to armpit. Mobilized vein was transposed subcutaneously to anterior location.
RESULTS: At present, 8 to 20 months after the procedure, venous pressures are within accepted ranges and hemodialysis is adequate.
CONCLUSIONS: Our technical report confirms that brachial vein can be utilized as the last option for creation of native vascular access on the upper arm. We recommend to perform the surgery in two separate stages. Maturation of the vein in its anatomical location between the 1st and 2nd stage of surgery assures proper dilatation and thickening of the vein which easier resists an extensive dissection and transposition during the 2nd stage.
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