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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 : 4  |  Page : 746-747
Release technique: Maturing arteriovenous fistula early


Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029, India

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Date of Web Publication26-Jun-2010
 

How to cite this article:
Gupta A, Khaira A, Bhatt AP, Jain S, Tiwari SC. Release technique: Maturing arteriovenous fistula early. Saudi J Kidney Dis Transpl 2010;21:746-7

How to cite this URL:
Gupta A, Khaira A, Bhatt AP, Jain S, Tiwari SC. Release technique: Maturing arteriovenous fistula early. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Dec 7];21:746-7. Available from: http://www.sjkdt.org/text.asp?2010/21/4/746/64668
To the Editor,

Cimino-Brescia radiocephalic arteriovenous fistula (AVF) created at wrist is the vascular access of choice in hemodialysis patients. [1] In the setting of late referral to nephrologists, when the patient is in stage 5 chronic kidney disease, early maturation of AVF is a nece­ssity. The usual time of maturation and use of AVF varies from 4-6 weeks. [2] We retrospec­tively analysed the data of our 50 patients who underwent a distal radiocephalic anastomosis at the wrist followed by underneath release of subcutaneous fascia, which we call it "release technique".

All the patients underwent AVF surgery for the first time and were clinically evaluated, which included inspection and palpation of the cephalic vein at the wrist and upper arm after applying a tourniquet on it. Normal dual blood supply was confirmed by Allen's test. Doppler mapping of vessels was not done, and non do­minant forearm was preferred. Xylocaine 2% local anaesthesia was administered into the operation site. Then, a 4-cm oblique skin inci­sion was made on the radial aspect of the wrist. Afterwards, the cephalic vein was dis­sected and ligated distally and disconnected. Following that, the patency and distensibility of the vein was assessed by heparin saline flushed using a 16-gauge cannula.

Then, the radial artery was exposed, and the cephalic vein was anastomosed to it using a proline 6-0 suture in end to side fashion. After that, the fistula patency was confirmed on the operating table by the presence of palpable thrill and/or bruit.

Immediately, the proximal forearm subcuta­neous fascia is released for about 3 inches from the anastomosis site using an artery for­ceps. Finally, the skin sutures were applied.

The primary failure with absent thrill and/or bruit was in 3(6%) patients, and 5 (10%) cases lost follow-up.

The available records of 42 cases at two weeks revealed a mean fistula blood flow of 702 mL/min (range 380-1002 mL/min). At 2 weeks, all fistulas were ≤ 0.6 cm deep and with diameter of at least ≥ 0.6 cm. All fistulas underwent successful cannulation at two weeks.

Various techniques of early maturation of AVF has been described [3],[4] but none achieved adequate maturation at two weeks.

The follow-up at 3 months revealed early fis­tula failure in two patients both of them had episode of hypotension.

The release technique seems to be useful and may be more so in patients who face problems with fistula patency due to their deep venous positions. The problems associated with cen­tral catheters placed for long, awaiting fistula maturation can be taken care of.

 
   References Top

1.Schwab SJ. Improving access patency: pre­end-stage renal disease strategies. J Am Soc Nephrol 1998;9:S124-9.  Back to cited text no. 1  [PUBMED]    
2.National Kidney foundation. NFK-K/DOQI Clinical Practice Guidelines for Vascular Access. Am J Kidney Dis 2006;48:S176-247.  Back to cited text no. 2      
3.Silva MB, Hobson RW, Pappas PJ, et al. Vein transposition in the forearm for autogenous hemodialysis vascular access. J Vas Surg 1997;26:981-6.  Back to cited text no. 3      
4.Weyde W, Krajewska M, Letachowicz W, Klinger M. Superficialization of the wrist native arteriovenous fistula for effective hemodialysis vascular access construction. Kidney Int 2002;61:1170-3.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Ankur Gupta
Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029
India
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PMID: 20587887

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