Microsurgical Arteriovenous Shunt on the Wrist in the Patients of End-stage Renal Disease

Yoo, Byung Sam; Yoo, Chang Hyun

Abstract

The ideal sites of vascular access are on the forearm, however, where superficial vein are usually poor due to the chronicity of the disease. Limitation of microsurgical technique forces to use upper arm or synthetic grafts in spite of the presence of small vessels. In this prospective study, we evaluated the success-rate of microsurgical arteriovenous shunt (AVS) using a microscope (M group) and compared the results with those using a loupe ( 3.5, L group) on the 95 patients from October, 1996 to April, 1998. The magnifiers were selected according to the external diameter of the vein, microscope below 1.5 mm. The results of operation were evaluated immediately after operation and were classified by the strength of thrill : strong thrill (ST); week thrill (WT); pulsation (P); none (F). The mean external diameters(mm) of the radial arteries and cephalic veins in both groups were 2.5; 2.3 (L) and 2.0; 1.3 (M), respectively (p<0.05). The immediate results of operation was ST,38; WT,11; P,2; N,0 in L group and ST,34; WT,10; P,1; N,0 in M group, which revealed no significant differences between both groups. After two months of operation, the rates of failure for vascular access were 5.9% (3/51) in L group 6.7% (3/45) in M group. In conclusion, small superficial veins on the wrist below 1.5 mm in diameter can be used successfully for vascular access with microsurgical technique using a surgical microscope.