| Theme | Progresses and Problems in Vascular Access for Hemodialysis | |
|---|---|---|
| Title | Brachiocephalic jump graft fistula | |
| Publish Date | 2009/07 | |
| Author | Naoki Haruyama | Kidney Center, Saiseikai Yahata Hospital |
| Author | Chikao Yasunaga | Kidney Center, Saiseikai Yahata Hospital |
| Author | Atsuhiro Maeda | Kidney Center, Aso Iizuka Hospital |
| Author | Kyoichi Fukuda | Department of Nephrology, Ekisaikai Moji Hospital |
| Author | Taihei Yanagida | Kidney Center, Saiseikai Yahata Hospital |
| Author | Tadanobu Goya | Kidney Center, Saiseikai Yahata Hospital |
| [ Summary ] | A brachiocephalic jump graft fistula, as described by Polo JR et al [Am J Kidney Dis1999; 33(5): 904-9], is beneficial in case of inadequate forearm and elbow crease veins, as well asdistantly located cephalic vein and brachial artery. The method has the advantages of easy construction with minimal vein dissection compared to an end-to-side brachiocephalic fistula, possible useof both proximal and distal arm veins for dialysis, and a low risk of infection. More specifically, two short longitudinal incisions are made over the brachial artery and the cephalic vein a few centimeters above the elbow crease. After dissectionof both vessels, a short segment of a PTFE graft istunneled between the incisions and its ends are anastomosed with the artery and the vein. Between 2000 and 2007, 26 brachiocephalic graft jump fistulas were constructed at the Kidney Center of Saiseikai Yahata Hospital. The secondary patency rate at 1, 3 and 5 years was 73.7%, 49.5%, and 49.5%, respectively. Fistula stenosis usually occurred close to the graft-vein anastomosis. Hemodynamic complications (steal syndrome or venous hypertension) were rarely observed. The brachiocephalic jump graft fistula is a reliable technical variation of upper arm fistulas for dialysis, and it can serve as another alternative for graft access. | |