Brachiocephalic Arteriovenous Fistula for Hemodialysis through the Median Antecubital Vein

Abstract

In patients unsuitable for radiocephalic fistula creation, the next option is brachiocephalic fistula. In such patients, we exploited the venous interconnections in the cubital fossa for median cubital vein-Brachiocephalic arteriovenous fistula (AVF) creation. In this article, we describe our experience in the creation of such technical variant of the brachiocephalic fistula AVF, its success and associated complications. A retrospective review of such AVF created between September 2014 and August 2015 was done. The data collected included demographics, co-morbidities, basic disease, operative details, patency, complications, and mortality. A total of 68 vascular access surgeries were done which included 26 (38.2%) brachiocephalic AVF using the median antecubital vein. The mean cephalic vein diameter and mean flow rate were 7.18 mm and 1415 ml/min, respectively 2 months after fistula creation. The primary and secondary failure rates were 3.87% and 7.69% respectively. Complications included aneurysm (7.69%), edema (19.23%), hematoma (11.53%), and wound infection (3.8%). Using reverse flow in the median antecubital vein is a safe and simple way to perform brachiocephalic AVF before brachiobasilic AVF and grafts.

Keywords: Arteriovenous fistula; smooth loop arteriovenous fistula; vascular access.

Figure 1

Operative anatomy of the cubital fossa

Figure 2

Brachiocephalic arteriovenous fistula through median antecubital vein at the elbow