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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 348-349
Evaluation of needle insertion sites in side-to-side elbow arteriovenous fistulas


1 Division of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 School of Nursing, Islamic Azad University, Qom, Iran

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Date of Web Publication9-Mar-2010
 

How to cite this article:
Moini M, Rasouli M, Nasiri HR, Aeenfar K. Evaluation of needle insertion sites in side-to-side elbow arteriovenous fistulas. Saudi J Kidney Dis Transpl 2010;21:348-9

How to cite this URL:
Moini M, Rasouli M, Nasiri HR, Aeenfar K. Evaluation of needle insertion sites in side-to-side elbow arteriovenous fistulas. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Nov 15];21:348-9. Available from: http://www.sjkdt.org/text.asp?2010/21/2/348/60210
To the Editor,

It seems that side-to-side anastomosis for crea­tion of elbow arteriovenous fistulas (AVF) pro­vides large room for insertion of the hemodia­lysis needles. However, there is concern about enough dilation of the veins around the elbow and some authors disrupt venous valves distal to the anastomosis to augment retrograde flow to the anastomosis. [1]

Current study was designed to test hypothesis that side-to-side anastomosis produce enough dilation in veins around the elbow and extends the possibility of needle insertion sites to distal and proximal ends of the elbow. The study was conducted at 4 hospitals in Tehran and all pa­tients with elbow AVF presented to these cen­ters for hemodialysis were recruited. Data in­cluding demographics and sites of insertion of hemodialysis needles were obtained by a blin­ded observer after cannulation of AVF by he­modialysis staffs who were also blinded to the study. Then, patient's notes were reviewed and cases with side-to-side elbow AVF were selec­ted and evaluated. Insertion of at least one he­modialysis needle below the elbow was the end point of our study. One hundred and one pa­tients including 58 men with mean age of 54.0 ± 14.0 years satisfied the inclusion criteria and entered the study. History of insertion of dual lumen catheter in central veins and AVF failure were found in 79 (78.2%) and 29 (28.7%) of cases, respectively. Comorbidities including dia­betes and hypertension were observed in 34 (33.6%) and 31 (30.7%), respectively. In 69 (68.3%) cases, at least one of the needles had been inserted distal to the elbow; in 14 (20.28%) cases both of the needles had been inserted distal to the elbow.

The results of our study showed that side-to­side AVF produces enough dilation in veins around the elbow especially distal to the anas­tomosis site besides simplicity of creation. [2] In spite of these advantages, the frequency of side­to-side elbow AVFs has been decreasing due to higher rate of complications such as steal syn­drome and venous hypertension than end-to­side AVF. [2] We have reported a modification in side-to-side brachiocephalic AVFs where the perforating vein is ligated during creation of AVF. [3],[4] This modification reduces significantly these complications while preserving the pri­mary patency rate of AVF. According to our results and these facts, we suggest side-to-side brachiocephalic AVFs with perforating vein ligation as the first choice of AVF at the elbow region because they are easy to create with appropriate patency rates and low complica­tions and provide more room for insertion of hemodialysis needles.

 
   References Top

1.Jennings WC. Creating arteriovenous fistulas in 132 consecutive patients: Exploiting the proximal radial artery arteriovenous fistula: Reliable, safe, and simple forearm and upper arm hemodialysis access. Arch Surg 2006;141:27-32.  Back to cited text no. 1  [PUBMED]    
2.Konner K, Nonnast-Daniel B, Ritz E. The arterio­venous fistula. J Am Soc Nephrol 2003;14: 1669-80.  Back to cited text no. 2  [PUBMED]    
3.Moini M, Rasouli MR, Nouri M. Ligation of the perforating vein: A treatment for steal syndrome in side-to-side elbow arteriovenous fistula. Ann Vasc Surg 2008;22:307.  Back to cited text no. 3      
4.Moini M, Williams GM, Pourabbasi MS, et al. Side-to-side arteriovenous fistula at the elbow with perforating vein ligation. J Vasc Surg 2008; 47:1276-81.  Back to cited text no. 4      

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Correspondence Address:
Majid Moini
Division of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran
Iran
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PMID: 20228529

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