Creating reverse flow arteriovenous fistulas with a forearm cannulation target

作者：Hyein Kim, Peter R. Nelson, Nasir Mushtaq, Alexandros Mallios, Kelly Kempe, Kimberly C. Zamor, Viraj Pandit, Steven Vang, William C. Jennings · 发表于：The Journal of Vascular Access · 年份：2021 · DOI：10.1177/11297298211039654 · 被引用次数：6 · 研究领域：Central Venous Catheters and Hemodialysis、Vascular Procedures and Complications、Diagnosis and Treatment of Venous Diseases

BACKGROUND: Establishing a forearm arteriovenous fistula (AVF) offers preferred cannulation sites and preserves proximal access opportunities. When a radiocephalic AVF at the wrist is not feasible and the upper arm cephalic and median cubital veins are inadequate, an AV graft or more complex access procedure is often required. Creating a retrograde flow forearm AVF (RF-AVF) is a valuable alternative where the mid-forearm median antebrachial or cephalic vein is adequate, offering forearm cannulation zones with AVF outflow through deep and superficial collaterals. We report our technique and results. METHODS: We retrospectively reviewed our vascular access data base of consecutive patients during an 11-year study period where a RF-AVF established the only available cannulation target in the forearm. In addition to physical examination, all patients had ultrasound vessel mapping. RESULTS: A forearm access was established with a RF-AVF as the only opportunity for cannulation in 48 patients. Ages were 14-86 years (median = 62 years). Forty-four percent female, 63% diabetic, 13% obese, and 29% had previous access operations. Inflow was proximal radial artery in 47 individuals and one proximal ulnar. Nine AVFs (19%) failed at 2-66 months (median 14 months). One RF-AVF was ligated due to arm edema. Follow-up was 2-111 months (median = 23.5 months). Primary and cumulative patency rates were 62% and 91% at 12 months, and 46% and 85% at 24 months. Five patients were lost to follow-up wi...