Arteriovenous Access superficialization: A New Technique and Review of Options
Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniq...
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Published in | Annals of vascular surgery Vol. 69; pp. 43 - 51 |
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Abstract | Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques.
The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and “trapped” directly under the dermis by closing the superficial fascia and adipose tissue beneath it.
Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8–10 weeks after superficialization.
This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature. |
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AbstractList | BACKGROUNDUp to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques.METHODSThe path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and "trapped" directly under the dermis by closing the superficial fascia and adipose tissue beneath it.RESULTSBetween March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8-10 weeks after superficialization.CONCLUSIONSThis technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature. Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been described previously. This study describes a new surgical technique for AVF superficialization and provides a review of the alternative techniques. The path of the fistula is marked using ultrasound, and transverse incisions are made along this path. The underlying tissue is separated from the dermis over this area to expose the fistula outflow vein. The mobilized vein is then elevated and "trapped" directly under the dermis by closing the superficial fascia and adipose tissue beneath it. Between March 2016 and February 2019, 23 patients underwent superficialization using this technique at two centers. The mean time between AVF creation and superficialization was 6.3 months, and the time to first use for hemodialysis after superficialization was 38.8 ± 27.9 days. The average presuperficialization depth was 7.1 ± 2.4 mm and average postsuperficialization depth was 3.7 ± 2.7 mm (P = 0.002). Sixteen fistulas were successfully accessed for a cannulation rate of 89%. 94.7% of fistulas remained patent at last visit, with only one thrombosed 8-10 weeks after superficialization. This technique appears to be both safe and effective, and results in a vein that is immediately subdermal without major contour deformity. Early outcomes are comparable to those alternative methods described in the literature. |
Author | Stafford, Alicia M. Illig, Karl A. Tanious, Adam Arhuidese, Isibor Chauhan, Yusuf M. Fontenot, Danielle T. |
Author_xml | – sequence: 1 givenname: Danielle T. surname: Fontenot fullname: Fontenot, Danielle T. email: daniellefontenot@usf.edu organization: Division of Vascular Surgery, University of South Florida, Tampa, FL – sequence: 2 givenname: Adam surname: Tanious fullname: Tanious, Adam organization: Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA – sequence: 3 givenname: Isibor surname: Arhuidese fullname: Arhuidese, Isibor organization: Division of Vascular Surgery, University of South Florida, Tampa, FL – sequence: 4 givenname: Yusuf M. surname: Chauhan fullname: Chauhan, Yusuf M. organization: Division of Vascular Surgery, University of South Florida, Tampa, FL – sequence: 5 givenname: Alicia M. surname: Stafford fullname: Stafford, Alicia M. organization: Division of Vascular Surgery, University of South Florida, Tampa, FL – sequence: 6 givenname: Karl A. surname: Illig fullname: Illig, Karl A. organization: Division of Vascular Surgery, Dialysis Access Institute, Orangeburg, SC |
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Cites_doi | 10.1097/00007611-197611000-00013 10.1097/00006534-199907000-00033 10.1111/j.1523-1755.2000.00391.x 10.5301/jva.5000217 10.1053/j.semvascsurg.2007.07.005 10.1016/j.jvs.2008.06.015 10.1016/j.jvs.2014.04.016 10.1001/archsurg.136.8.929 10.1016/j.jvs.2015.10.063 10.5301/jva.5000353 10.1016/j.jvs.2016.01.004 10.1177/1129729820901654 10.1097/00002480-197902500-00064 10.1067/mva.2003.181 10.1016/j.jvs.2016.10.081 10.1016/j.jvs.2009.03.009 10.1016/j.avsg.2015.02.004 |
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Snippet | Up to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs have been... BACKGROUNDUp to 30% of autogenous cephalic vein arteriovenous fistulas (AVFs) are too deep for reliable cannulation. Techniques to superficialize these AVFs... |
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SubjectTerms | Arteriovenous Shunt, Surgical Brachial Artery - diagnostic imaging Brachial Artery - surgery Catheterization Dissection - adverse effects Female Humans Male Radial Artery - diagnostic imaging Radial Artery - surgery Renal Dialysis Retrospective Studies Treatment Outcome United States Upper Extremity - blood supply Vascular Patency Veins - diagnostic imaging Veins - surgery |
Title | Arteriovenous Access superficialization: A New Technique and Review of Options |
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