Efficacy of brachial and forearm vein bypass surgery at elbow in hemodialysis patients with communicating veins showing resistance to vascular access intervention therapy

Abstract

For arteriovenous fistula (AVF) creation in forearms of hemodialysis patients, patency can be achieved via communicating veins, even when median cubital veins are occluded. Communicating veins can be maintained by vascular access intervention therapy (VAIVT), but switching to new AVF may be necessary if patients develop VAIVT resistance. We performed elbow bypass surgery for 16 such VAIVT-resistant patients. In each case, dialysis was possible via puncture sites created the day after surgery. Secondary patency was 88％ (14 cases) 1 year after surgery, 63％ (10 cases) 2 years after, and 44％ (7 cases) 3 years after. Surgery to bypass the brachial and forearm veins at the elbow may be efficacious. Patients with favorable vascular conditions of the forearm should be selected for this surgery, and long-term patency can be expected with appropriate post-operative VAIVT support.