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When creating a cephalic fistula below the elbow fold, the other collaterals must be ligated to perform the anastomosis, from the cephalic vein to the brachial artery.
With this technique communication with the basilica can be preserved. A slow maturation of the basilic vein, without causing steal syndrome or significantly interfering with the maturation of the cephalic vein.
It also does not cause overload to the right ventricle.
If the cephalic vein is not develop or longer viable as vascular access, the mature basilic vein can be used for cephalic repair, usually for proximal stenosis or complete transposition.
Between April 2016 and June 2023, we performed 2,352 surgeries, 72 of which utilized this technique.
Average age 30-72 years old.
Patient included 48 males, 24 females, of whom 45 patients; 62.5% having diabetes, 37 patients; 51,3% prior to entering dialysis high blood pressure.
This technique consist of doing a good dissection and mobilizing of the vessels, use the middle vein for the anastomosis, ligating all the branches except the middle vein; or ligated middle vein included, and performing the anastomosis with basilic side to side.
The idea is to preserve flow to the basilic and cephalic veins, and ligate the basilic to create 90% of the stenosis. In this way 5 to 10% of blood flow is going to basilic, and at least 90% to the cephalic.
In 16 (22,2%) cases, complete transposition of the basilic was necessary after an interval of 2 months, due to lack of development of the cephalic vein.
In 24 (33.3 %) patients between 18 and 48 months required basilic vein interposition for repair proximal cephalic vein stenosis.
100% of these patients were able to undergo dialysis, in which the basilica was used as a spare vein for the cephalic vein, either:
A- as a complete transposition
B- or as a repair.
Patency rates were, Mean follow-up was 24 month primary patency rate was 97.3%.
We had no infections
Favored by not using synthetic prostheses, AVFs with veins practically do not become infected, and we are rigorous with asepsis.
No patient developed a steal syndrome.
Although it is somewhat more technically demanding and increases surgical time by approximately 10 to 20 minutes.
This technique has given very positive results.
- Avoid:
synthetic prostheses
catheter exposure time in patients.
exhaustion of vascular accesses.
- In addition, it offers the possibility of preserving the patient's native fistula.