Proximal Ulnar Artery Arteriovenous Fistula Inflow is an Uncommon but useful Vascular access Option

2017 ◽  
Vol 18 (6) ◽  
pp. 488-491 ◽  
Author(s):  
William C. Jennings ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Ulnar Artery ◽  
Allen’S Test ◽  
Brachial Vein ◽  
Anatomic Variants ◽  
Allen's Test ◽  
Doppler Evaluation

Introduction A proximal ulnar artery arteriovenous fistula (PUA-AVF) is a logical vascular access option when the distal ulnar artery is occluded or inadequate in addition to other specific vascular anatomic variants. This study reviews a series of patients where the proximal ulnar artery was used for AVF inflow in establishing a reliable autogenous access for these uncommon patients. Materials and methods All new patients referred for vascular access with a PUA-AVF created during an eight-year period were evaluated. In addition to physical and ultrasound examinations, all patients had an Allen's test performed augmented with Doppler evaluation of the palmer arch. Analysis placed these patients into three anatomic groups: 1) A dominant radial artery with distal ulnar artery occlusive disease; 2) No cephalic or basilic vein option with an isolated and intact brachial vein originating from the ulnar vein for later staged transposition; 3) A proximal radial artery ≤2 mm in diameter and a normal Doppler augmented Allen's test. Results PUA-AVFs were created in 32 new patients during an eight-year period. Primary and cumulative patency rates were 80% and 94% at 12 months and 55% and 81% at 36 months. Follow-up was 2-62 months (mean 14 months). No patients developed steal syndrome during the study period. Conclusions A PUA-AVF is a safe and reliable autogenous access. It is particularly important when the radial artery is the only or dominant arterial supply to the hand, in patients with small but patent radial arteries, and in selected individuals requiring a brachial vein transposition.

A Quantitative Allen's Test

HAND ◽  
1981 ◽  
Vol os-13 (3) ◽  
pp. 318-320 ◽  
Author(s):  
M. Scavenius ◽  
M. Fauner ◽  
S. Walther-Larsen ◽  
C. Buchwald ◽  
S. L. Nielsen
Keyword(s):  
Radial Artery ◽  
Systolic Pressure ◽  
Ulnar Artery ◽  
Normal Subjects ◽  
Arterial Supply ◽  
Allen’S Test ◽  
Allen's Test

Allen's test has been performed quantitatively by measuring digital systolic pressure during compression of the radial or ulnar artery at the wrist. The reduction of pressure in normal subjects was less than 25 per cent. Insufficiency of the arterial supply to the hand from the radial artery, the ulnar artery or the palmar arcades can easily be diagnosed from an abnormal reduction in digital systolic pressure during arterial compression.

scholarly journals CORRELATION BETWEEN ALLEN’S AND INVERSE ALLEN’S TESTS WITH DIAMETERS OF ULNAR AND RADIAL ARTERIES

2013 ◽  
Vol 5 (2) ◽  
Author(s):  
Alice I. Supit ◽  
Bambang Budiono ◽  
Reginald L. Lefrandt
Keyword(s):  
Radial Artery ◽  
Ulnar Artery ◽  
Analysis Software ◽  
Access Site ◽  
Correlation Test ◽  
Spearman's Rho ◽  
Allen’S Test ◽  
Spearman’S Rho ◽  
The Mean ◽  
Allen's Test

Abstrak: Arteri radialis semakin sering dipergunakan sebagai akses alternatif angiografi koroner dan intervensi karena dibanding akses femoralis, komplikasi perdarahan lebih rendah, mobilisasi lebih dini, dan biaya lebih murah. Terdapat beberapa hal yang dapat mengurangi keberhasilan prosedur ini; salah satunya ialah kegagalan pungsi karena ukuran a. radialis yang kecil. Studi sebelumnya menunjukkan bahwa uji Allen dapat digunakan untuk mendeteksi arteri dengan diameter yang lebih besar. Penelitian ini bertujuan untuk mengevaluasi apakah uji Allen dan inverse Allen berkorelasi dengan diameter a. ulnaris dan a. radialis. Penelitian ini berlangsung dari Juli hingga Desember 2012 di Laboratorium Kateterisasi Rumah Sakit Awal Bros Makassar. Pasien menjalani uji Allen dan inverse Allen sebelum prosedur. Ukuran diameter dalam dari lumen arteri radialis dan ulnaris diukur oleh operator dengan menggunakan analisis angiografi kuantitatif (operator tidak mengetahui hasil uji Allen). Uji Spearman’s rho digunakan untuk menganalisis korelasi antara uji Allen dan inverse Allen dengan diameter a. radialis dan a. ulnaris dengan P < 0,05 dianggap bermakna. Analisis statistik menggunakan SPSS versi 19. Hasil penelitian memperlihatkan 121 pasien (98 laki-laki dan 23 perempuan, rerata usia 57,5 (SD ± 11,9 tahun). Frekuensi crossover 3,3%. Uji Allen dan inverse Allen normal pada 116 pasien (95,8%). Rerata diameter a. radialis dan ulnaris ialah 2,14 (SD ± 0,34 mm) dan 1,95 (SD ± 0,45 mm). Uji korelasi Spearman’s rho menunjukkan korelasi bermakna antara uji Allen dan diameter a. ulnaris (P = 0,000; r = -0,485); uji inverse Allen dan diameter a. radialis (P = 0,015; r = -0,220). Simpulan: Terdapat korelasi bermakna antara uji Allen  dengan diameter a. ulnaris, dan uji inverse Allen dengan diameter a. radialis. Kedua uji ini sederhana dan dapat memberikan informasi tentang arteri mana memiliki diameter yang lebih besar. Bila uji Allen normal, maka a.ulnaris dapat dipergunakan sebagai akses alternatif ketika akses radialis gagal atau bahkan sebagai akses inisial jika uji inverse Allen abnormal atau waktu uji Allen lebih singkat dari inverse Allen, terutama untuk prosedur intervensi yang memerlukan arteri yang lebih besar sebagai akses. Kata kunci: uji Allen, uji inverse Allen, diameter, arteri radial, arteri ulnaris.   Abstract: Radial artery has been increasingly used as an alternative site for coronary angiography and intervention because of its advantages over femoral access, such as: a reduction in bleeding complications, early mobilisation, and lower cost. Despite these advantages, there are some challenges that reduce procedural success. One of them is the puncture failure owing to the small vessel size. A previous study has demonstrated consistently that the Allen test may be used for detecting the artery with the largest diameter. This study aimed to evaluate whether the Allen’s and inverse Allen’s tests correlate to the diameters of ulnar and radial arteries. This study was conducted from July to December 2012 in the Catheterization Laboratory of Awal Bros Hospital Makassar. Patients underwent the Allen’s and inverse Allen’s test before the procedure. The inner luminal diameters of radial and ulnar arteries were measured by an operator using quantitative angiographic analysis software. The operator was blinded to the results of the Allen’s tests. The Pearson correlation test was used to analyze the correlation between Allen’s and inverse Allen’s test with the diameters of the radial and ulnar arteries. A P-value of < 0.05 was considered as statistically significant. Statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 19. The results showed that there were 121 patients (98 males and 23 females, the mean age being 57.5 (SD ± 11.9 years). The crossover rate was 3.3%. Both of the Allen’s and inverse Allen’s tests were normal in 116 patients (95.8%). By using a quantitative coronary analysis software, the mean diameters of the radial and the ulnar arteries were  2.14 (SD ± 0.34 mm) and 1.95 (SD ± 0.45 mm), respectively. The Spearman’s rho correlation test showed significant correlations between the Allen’s test and diameters of ulnar arteries (P = 0.000; r = -0.485), and between the inverse Allen’s test and diameters of radial arteries (P = 0.015; r = -0.220). Conclusion: The Allen’s test correlated to the diameters of the ulnar arteries and the inverse Allen’s test correlated to the diameters of the radial arteries. The normal Allen’s test indicated that the ulnar artery might be used as an alternative access site when the radial approach failed or even as an initial access if the inverse Allen’s test was abnormal or the Allen’s test was shorter than the inverse Allen’s test, especially for the intervention procedure which needed a larger artery as the access site. These tests are simple and may provide some important information about arteries with larger diameters. Future studies with larger series of patients will be necessary to confirm our results. Keywords: Allen’s test, inverse Allen’s test, diameter, radial artery, ulnar artery.

Superficialization of Basilic Vein: Last Chance for a Native Arteriovenous Fistula in Hemodialysis Patients

2003 ◽  
Vol 4 (1) ◽  
pp. 21-24 ◽  
Author(s):  
M. Onaran ◽  
D. Erer ◽  
I. Şen ◽  
E.E. Elnur ◽  
E. Iriz ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
Subcutaneous Tissue ◽  
Vascular Grafts ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Number Of Patients

Background Although the best type of vascular access for chronic hemodialysis patients is a native arteriovenous fistula, in an increasing number of patients all the superficial veins have been used and only the placement of vascular grafts or permanent catheters is left. Superficialization of the basilic vein is a possible alternative. Materials and Methods In 49 chronic hemodialysis patients who had no possibilities to have a native arteriovenous fistula created, we performed a basilic vein- brachial artery fistula in the arm. During the same operation the basilic vein was then superficialized for easier access for hemodialysis. Results Mean follow-up was 22.36±15.56 months. Forty-eight patients are still undergoing hemodialysis with their superficialized basilic vein native A-V fistula without any complications. Only one fistula was thrombosed just after the procedure because of poor vessel quality. Conclusion For hemodialysis patients who have no suitable superficial veins at the wrist or elbow, performing a basilic vein - brachial artery fistula and superficializing the vein to the subcutaneous tissue is an acceptable choice before deciding to use more complicated procedures like vascular grafts.

Brachio-brachial arteriovenous fistula combined with superficialization of the brachial artery using a short skin incision for hemodialysis

2020 ◽  
pp. 112972982094408
Author(s):  
Tsuyoshi Takashima ◽  
Yui Nakashima ◽  
Atsuhiko Suenaga ◽  
Yuki Yamashita ◽  
Yasunori Nonaka ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
English Literature ◽  
Invasive Procedure ◽  
Skin Incision ◽  
Related Data ◽  
One Stage ◽  
Long Time ◽  
Brachial Vein

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2–3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.

scholarly journals Distal radial artery ligation for treatment of steal syndrome associated with radiocephalic arteriovenous fistula

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Mahmoud Tolba ◽  
Martin Maresch ◽  
Dhafer Kamal
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Hemodialysis Patient ◽  
Ulnar Artery ◽  
Complete Relief ◽  
Retrograde Flow ◽  
Palmar Arch ◽  
Artery Ligation ◽  
Steal Syndrome ◽  
Distal Radial Artery

Abstract We present a case of dialysis associated steal syndrome in a hemodialysis patient with left radiocephalic arteriovenous fistula that caused him severe rest pain. Angiography showed retrograde flow from the ulnar artery to the distal radial artery through a hypertrophied palmar arch. The problem was solved by surgical ligation of the distal radial artery leading to complete relief of patient symptoms without any notable complications.

Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation

2020 ◽  
pp. 112972982093692
Author(s):  
Alexandros Mallios ◽  
Pierre Bourquelot ◽  
Ghazi Harika ◽  
Benoit Boura ◽  
William C Jennings
Keyword(s):  
Radial Artery ◽  
Secondary Patency ◽  
Inclusion Criteria ◽  
Technical Success ◽  
Second Stage ◽  
Hand Ischemia ◽  
Single Center Study ◽  
Radial Vein ◽  
Brachial Vein

Objective: We evaluate the creation of a percutaneous proximal radial artery–radial vein arteriovenous fistula with Ellipsys® instead of the usual first-stage brachial artery fistula prior to a second-stage brachial vein elevation, in patients with inadequate cephalic and basilic veins. Methods: Single center study of eight patients (six males, mean = 54 years) who underwent a two-stage brachial vein elevation procedure between May 2017 and October 2019. Inclusion criteria were life expectancy > 6 months, patent brachial and proximal radial artery (>2 mm in diameter) absent/inadequate cephalic and basilic veins, existence of a brachial vein >3 mm in diameter, and in continuity with a proximal radial vein > 2 mm in diameter. Results: Technical success was 100%. Four patients required angioplasty of a juxta-anastomotic stenosis, accounting for a 6-month primary and secondary patency rates were 68% and 100%, respectively. Access flow averaged 982 mL/min (range 768–1586) at final follow-up evaluation. There were no significant adverse events related to the procedures. All fistulae were elevated at 4–12 (mean: 8) weeks post creation and were successfully cannulated with two needles after healing was completed (2–4 weeks after elevation). No patients developed hand ischemia or arm edema. Conclusions: Percutaneous creation of a proximal radial artery–radial vein fistula followed by brachial vein elevation is a safe and reliable option for autogenous access creation in patients with inadequate cephalic or basilic veins. Minimally invasive radial artery inflow and longer available length of the targeted brachial vein available for elevation are the main advantages in skilled hands.

scholarly journals Proximal radial artery arteriovenous fistula for hemodialysis vascular access

2018 ◽  
Vol 67 (1) ◽  
pp. 244-253 ◽  
Author(s):  
William C. Jennings ◽  
Alexandros Mallios ◽  
Nasir Mushtaq
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Hemodialysis Vascular Access

scholarly journals Pre-existing arterial microcalcification and arteriovenous fistula failure

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Nenad Petković ◽  
Radoslav Gajanin ◽  
Ljubica Djukanović
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Hematoxylin And Eosin

Arterial microcalcification is common in patients with chronic kidney disease (CKD) and presents a significant predictor of both general and cardiovascularmortality. The study involved 22 patients (14 males, aged 60.5± 12.1) with chronic kidney disease (eGFR 11.9 ± 2.3 ml/min/1.73m2) undergoing their first AVF surgery. Radial artery specimens obtained from all patients during AVF creation were fixed and stained with hematoxylin and eosin for semiquantitative calcium quantification. Arterial microcalcification wasfound in ten (40.9%) patients. During 30 months after AVF surgery nine patients died, seven with a functioning AVF. Among these nine patients arterial microcalcification was found in five (p = 0.16). During the follow-up period unassisted AVF failure occurred in four (18.2%) patients, one of whom had arterial microcalcification (p=0.47). 

Abstract 315: Feasibility of Arteriovenous Fistula Creation After Previous Radial Artery Harvesting for Aortocoronary Bypass

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Nicholas J Gargiulo
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Ulnar Artery ◽  
Aortocoronary Bypass ◽  
Palmar Arch ◽  
Sestamibi Scanning ◽  
Preoperative Work Up ◽  
Work Up ◽  
Forearm Muscle ◽  
Steal Syndrome

Background: Arteriovenous fistula (AVF) formation remains the procedure of choice in patients requring hemodialysis. The feasibility of AVF creation in the setting of prior radial artery harvesting after aortocoronary bypass remains unknown. This investigation elucidates which patients might be candidates for AVF creation despite prior radial artery harvesting. Methods: A retrospective review was performed on 2,100 patients undergoing hemodialysis access procedures from 2003 to 2010. Of these patients, 11 (0.5%) were identified as having prior radial artery harvesting for aortocoronary bypass. Pre/Post-operative vein mapping, arterial duplex, digital plethysmography, selective angiography, and sestamibi scanning was performed to evaluate the ulnary artery and palmar arch. Patients with evidence suggesting an intact ulnar artery circulation then underwent AVF creation. Results: All 11 patients had an adequate preoperative work up. Seven (64%) of the 11 patients had digital plethysmography suggesting an intact ulnar artery/palmar arch and underwent successful AVF creation. Three (27%) of the patients had a variety of findings precluding successful AVF creation. One (9%) patient with normal preoperative plethysmography developed a steal syndrome requiring revision of the arteriovenous fistula. Conclusions: Successful AVF creation is feasible in patients with prior radial artery harvesting for aortocoronary bypass. The use of preoperative digital plethysmography, selective ulnar artery/palmar arch arteriography and sestamibi scanning to evaluate forearm muscle perfusion may be used as adjuncts to guide a successful intervention.

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