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- Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case reportPublication . Costa, Luísa Lemos; Matos, António Norton; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Campos, Luís; Delgado, Elisabete; Oliveira, Debora; Campos, Tiago; Inácio, Marta; Fernandes, Filipa; Coutinho, Sara; Ventura, Ana; Pereira, Susana; Castro, Ana; Xavier, Eva; Sousa, Clemente NevesThe distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.
- Radio-cephalic fistula recovered with drainage to forearm basilic veinPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Teixeira, Gabriela; Rego, Duarte; Teixeira, SérgioDysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.
- Two-Stage Basilic Vein Transposition: Second Stage ResultsPublication . Rego, Duarte; Nogueira, Clara; Matos, António; Almeida, Paulo; Queirós, José; Silva, Fernanda; Sousa, Clemente Neves; Almeida, RuiThe increasing survival of hemodialysis patients results in the depletion of superficial venous capital justifying the use of the basilic vein. Many groups still prefer an arteriovenous graft due to transposition complexity and the time needed to achieve maturation. In this work we review the results of our series of basilic vein transpositions (BVT). BVTs were performed in two stages: first, creation of the fistula; second, transposition of the vein using three small incisions in the arm. All patients had to have direct arterialization of the basilic vein, therefore, patients with previous ipsilateral wrist fistulas also followed a two-stage protocol. Data were retrospectively revised from all transposition procedures made between September 2005 and November 2012. Patency and complication rates were the primary outcomes evaluated. A total of 276 basilic veins were transposed. Usage rate was 82.2%. 8% (N = 22) of the fistulas were never used due to thrombosis. Secondary patency rates at 1 and 2 years were, respectively, 84% and 66.3%. Complications occurred in 61.6% (N = 170) of fistulas and 65.9% (N = 112) of which had to undergo surgical or endovascular revision. The most frequent complication was vein stenosis (39.7% of late complications, N = 92). Albeit its greater technical complexity, the transposed basilic vein represents a hemodialysis access with good patency rates. Complication rates, although high, are less than those of CVC or prosthetic grafts. These results support the use of the transposed basilic vein as hemodialysis access after the brachiocephalic fistula.
- Ruptured arteriovenous fistula pseudoaneurysm treatment by balloon‐assisted direct percutaneous thrombin injectionPublication . Loureiro, Luís; Mendes, Daniel; Sousa, Clemente Neves; Almeida, Paulo; Norton de Matos, António; Teles, Paulo; Rego, Duarte; Teixeira, Gabriela; Teixeira, Sérgio; Antunes, Inês; Costa, Luísa Lemos
- Brachial-cephalic fistula recovered with drainage for the basilic vein: Case reportPublication . Sousa, Clemente Neves; Norton de Matos, António; Rocha, Ana; Almeida, Paulo; Xavier, EvaVascular access is essential for the implementation of hemodialysis (HD). The arteriovenous fistula (AVF) can be constructed in various locations using various veins. However, the quality of the veins will influence the construction site, as well as the functioning of the AVF. Careful analysis of the vascular network allows options for the development of new fistulas presentations. We present and discuss the case of a woman aged 69 years in HD in which a brachial-cephalic fistula with drainage to basilic vein was created, through rotation of the cephalic vein on the forearm level. This kind of access serves to prolong the time spent dialyzing through native fistulae, with their reduced complications and greater cost-effectiveness.
- Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature ReviewPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Rego, Duarte; Teixeira, Gabriela; Loureiro, Luís; Teixeira, Sérgio; Antunes, InêsVascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.
- Brachio-Brachial Arteriovenous Fistula Superficialization with Short Skip IncisionsPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Queirós, José; Rego, Duarte; Teixeira, Gabriela; Loureiro, Luís; Teixeira, SérgioThe exhaustion of superficial venous patrimony or reduced diameter of superficial veins usually prevents patients from having an arteriovenous fistula created. In such cases, using deep vessels can be a more viable option as opposed to an arteriovenous graft. We describe a new approach for the brachio-brachial arteriovenous fistula creation technique. It consists of 3 small incisions, thus causing minimal surgical damage. We have found it to be better tolerated by the patients and well received by dialysis nurses. This procedure also allows improved access for cannulation and more available puncture sites.
- Arteriovenous access banding revisitedPublication . Teixeira, Gabriela; Almeida, Paulo; Sousa, Clemente Neves; Teles, Paulo; De Sousa, Paulo; Loureiro, Luís; Teixeira, Sérgio; Rego, Duarte; Almeida, Rui; Norton de Matos, AntónioThe aim of this study is to validate the current applicability of arteriovenous access banding in high flow access (HFA) and/or haemodialysis access-induced distal ischaemia (HAIDI). This retrospective study was conducted at the GEV (Grupo de Estudos Vasculares) vascular access centre. The clinical records of consecutive patients undergoing banding for HAIDI and HFA symptoms, between June 2011 and January 2015, were reviewed until April 2015. All vascular access patients’ consultation records and surgical notes were reviewed. We analysed and compared patients’ age, gender, comorbidities, symptoms and intraoperative ultrasound control. We defined technical failure as recurrence of symptoms, requiring new banding. Excessive banding, access thrombosis, rupture and false aneurysm development were registered as complications. Primary clinical success was defined as improvement of symptoms or effective flow reduction after banding, with no need for reintervention. If one reintervention was necessary, we have defined it as secondary clinical success. Overall, 119 patients underwent banding: 64 (54%) with HAIDI and 55 (46%) with HFA. The HAIDI group was significantly older (65 ± 13 years compared with 56 ± 22 years, p = 0.001) and had significantly greater number of patients with diabetes (56% vs 24%, p = 0.004). Primary success was achieved in 85 patients (71.4%) and the secondary success rate was 84.9%. Older age (p = 0.016) and intraoperative ultrasound control (p = 0.012) were significantly associated with primary success. Our results do not corroborate the high incidence of thrombosis previously reported as associated with AV access banding and suggest that ultrasound control is crucial for preventing technical failure. The procedure was effective on both compared groups.
- Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case reportPublication . Costa, Luísa Lemos; de Matos, António Norton; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Campos, Luís; Delgado, Elisabete; Oliveira, Debora; Campos, Tiago; Inácio, Marta; Fernandes, Filipa; Coutinho, Sara; Ventura, Ana; Pereira, Susana; Castro, Ana; Xavier, Eva; Sousa, Clemente NevesThe distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.
- Outflow Rescue of Elbow-Blockade Forearm Arteriovenous Fistulas: Outcomes of Open Surgical TechniquesPublication . Mendes, Daniel; Almeida, Paulo; Sousa, Clemente Neves; Loureiro, Luís; Teixeira, Sérgio; Rego, Duarte; Norton-de-Matos, AntónioBackground Venous scarring at the elbow is a common problem that can cause early and late forearm arteriovenous fistula (AVF) dysfunction in hemodialysis patients. However, any effort to prolong the long-term patency of distal vascular accesses could benefit the patient's survival, maximizing the use of restricted venous patrimony. This study aims to report a single-center experience in the recovery of distal autologous AVF with venous outflow obstruction at the elbow using different surgical techniques. Methods Retrospective observational study of all patients treated at a single vascular access center from January 2011 to March 2022, with dysfunctional forearm AVFs presenting with outflow stenosis or occlusions at the elbow treated by open surgery, using 3 different surgical techniques. Demographics and clinically relevant data were collected. Evaluated endpoints included primary, assisted primary, and secondary patency rates at 1 and 2 years. Results Twenty-three patients with elbow-blocked outflow forearm AVFs have been treated with a mean age of 64 ± 15 years. The majority (96%) had a radiocephalic fistula. The median time from vascular access creation to intervention was 34.5 months (12–216 months). A total of 24 procedures have been performed using 3 different surgical techniques for bypassing the obstructed venous outflow at the elbow. Technical success was achieved in 96% of the surgically treated patients. Primary and secondary patency rates at 1 year were 67.4% and 89.4%, respectively, and 52.9% and 82.0% at 2 years, with a median follow-up of 19 months (6–92 months). Conclusions AVFs outflow stenosis or occlusions at the elbow not amenable to endovascular therapy could lead to vascular access abandonment. Our study demonstrates multiple surgical solutions to avoid this adverse outcome. Elbow venous outflow surgical reconstruction seems effective for distal vascular access preservation. Close surveillance is essential for timely endovascular treatment of newly developed stenosis at the venous drainage.