Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 231-236

The utility of venous bifurcation for anastomosis with small-caliber veins in distal forearm radiocephalic arteriovenous fistula: Retrospective analysis of 52 fistula cases

1 Department of Plastic Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
2 Dezire Clinic, New Delhi, India
3 Department of Plastic and Reconstructive Surgery, Sir Ganga Ram Hospital, New Delhi, India

Correspondence Address:
Sudipta Bera
Department of Plastic Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijves.ijves_84_19

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Context: Distal forearm radiocephalic (RC) arteriovenous fistula (AVF) is the gold standard for vascular access for hemodialysis. The use of venous bifurcation to facilitate anastomoses in small-caliber vessels is well known in microvascular surgery. Small-caliber cephalic vein (CV) is frequently encountered during AVF creation in the distal forearm. We present here the utility of this technique for the creation of distal RC AVF in small-caliber CVs. Objective: The objective was to assess the utility of venous bifurcation for distal forearm RC AVF creation in small-caliber CV. Methodology: Fifty-two cases with CV diameter <2.5 mm on color Doppler study and RC AVF created in the distal forearm between January 2015 and 2019 are reviewed for operative time, fistula maturation time, and patency rate. Patients were selected for fistula creation after clinical and color Doppler assessment. Cephalic venous bifurcation in the distal forearm was used for end-to-side anastomosis whenever feasible. Patients were followed up periodically for fistula maturation and patency. Results: Venous bifurcation was used in all 52 cases with a functional maturation rate 48/52 (92.30%). Functional primary patency rate was 46/52 (88.46%) at 6 months and 20/28 (71.42%) at 1 year. The mean fistula maturation time was 37.19 days. Conclusion: A cephalic venous bifurcation is almost always available for RC AVF in the distal forearm. Its utilization improves the success rate and feasibility of fistula creation in small-caliber veins without any delay.

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