Primary arteriovenous fistula inflow proximalization for patients at high risk for dialysis access-associated ischemic steal syndrome William C. Jennings,

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Presentation transcript:

Primary arteriovenous fistula inflow proximalization for patients at high risk for dialysis access-associated ischemic steal syndrome William C. Jennings, MD, Robert E. Brown, MD, Carmen Ruiz, MD Journal of Vascular Surgery Volume 54, Issue 2, Pages 554-558 (August 2011) DOI: 10.1016/j.jvs.2011.01.031 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Schematic and clinical images of a primary proximal arterial inflow autogenous vascular access. An axillary artery end-to-side anastomosis supplied arteriovenous fistula inflow and a reversed basilic vein transposition completed access outflow to the cephalic vein, offering bidirectional outflow and multiple cannulation sites. Journal of Vascular Surgery 2011 54, 554-558DOI: (10.1016/j.jvs.2011.01.031) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Schematic and clinical images show a proximal arterial inflow transposition arteriovenous fistula. Retrograde flow through the mobilized basilic vein was established with a valvulotome before the the axillary artery end-to-side anastomosis was constructed. Outflow was preserved through collateral veins into the brachial veins. The transposition was completed by superficializing the basilic vein within a narrow longitudinal flap created along the anterior margin of the incision. Journal of Vascular Surgery 2011 54, 554-558DOI: (10.1016/j.jvs.2011.01.031) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 Clinical images show a tunneled basilic vein transposition arteriovenous fistula (AVF) based on axillary artery inflow. Irrigation of the vein confirms successful valvulotomies with AVF outflow into the brachial veins through multiple collaterals. Retrograde outflow through the mobilized basilic vein was established with a valvulotome before the AVF anastomosis was constructed. *Cardinal Health-Medical Products and Services, St. Louis, Missouri. Journal of Vascular Surgery 2011 54, 554-558DOI: (10.1016/j.jvs.2011.01.031) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 Schematic and clinical images show a saphenous vein translocation arteriovenous fistula (AVF) with proximal arterial inflow from the axillary artery. Outflow was established by an end-to-side anastomosis to a distal arm brachial vein. We consider using a saphenous vein as a dialysis access conduit for cannulation only when the vein is ≥6 mm in diameter. Journal of Vascular Surgery 2011 54, 554-558DOI: (10.1016/j.jvs.2011.01.031) Copyright © 2011 Society for Vascular Surgery Terms and Conditions