부산대학교 도서관

The mean age of overall dialysis population and the incidence of diabetic patients has been increasing. With these changes, we have sometimes encountered hemodialysis patients with difficulty in creating blood access. In these patients, we try to construct an arteriovenous fistula (AVF) utilizing brachial artery and brachial vein following superficial repositioning, before deciding whether to implant an artificial graft or to puncture an artery directly. We describe our surgical procedure and the results.Between January 1996 and December 2000, fifteen blood access routes were established by this technique in 11 patients without suitable veins for standard AVF in the upper extremities. Our procedure involves two steps, one is constructing the AVF and the other is superficial repositioning of these vessels. Four blood access routes were created in one stage in which the two steps were performed at the same time. Eleven blood access routes were created in two stages in which the two steps were separated into two operations. The mean duration of the superficialized veins remaining patent was greater in the two-stage group than in the one-stage group (15.2 months in the two-stage group, 2.8 months in the one-stage group). Of 11 fistulae constructed in two stages, 8 fistulae were patent after 1 year. Arterial rupture, steal syndrome, formation of aneurysm and the excessive blood flow in the AVF were observed as complications. Therefore this procedure requires care and the superficialized brachial artery should be used as backup access.This technique facilitated the establishment of blood access in patients with vascular access complications to avoid using an artificial graft or puncturing an artery directly. We conclude that this procedure is useful for establishing secondary blood access.