Arteriovenous Fistula Formation with Prosthetic Graft Using the Vena Comitantes as a Venous Outflow

Lee, Gun; Lim, Chang Young; Lee, Hyeon Jae

Abstract

BACKGROUND
Arteriovenous fistula formation is not always easy to perform in hemodialysis patients because of poor preservation of veins due to repeated venipuncture and cannulation. We analyzed the patency rate and complications of prosthetic arteriovenous fistulas using the vena comitantes as a venous outflow in the antecubital fossa, which are protected from venipuncture. MATERIAL AND METHOD: Between January 2006 and June 2008, 12 patients underwent prosthetic arteriovenous fistula formation using the vena comitantes as a venous outflow. Arterial inflow was via the brachial artery and the graft was placed in a loop fashion. The male-to-female ratio was 7:5 and the mean age was 59+/-14 years. Six patients had diabetes mellitus and 10 patients had hypertension. RESULT: There were no complications, such as a graft infection or bleeding. Five patients showed postoperative stenosis at an average of 3 months. The primary patency rate was 75.0, 65.6, and 52.2% at 3, 6, and 12 months, respectively. All the patients with stenosis were able to continue hemodialysis after intervention therapy. The secondary patency rate was 100% at 12 months.
CONCLUSION
Creation of a prosthetic arteriovenous fistula using uninjured vena comitantes resulted in a good patency rate and this vein may become a substitute for inappropriate superficial veins.