Abstract
The site of first choice for creating an arteriovenous fistula (AVF) is still the distal forearm at the wrist or the anatomical snuff box (Tabaciere).
However, there are patients in whom this is impossible. This might be because the forearm veins are too small or have been severely damaged by frequent venopunctures or pre-existing AVF.
Patients with diabetic nephropathy, senile patients and those undergoing long term hemodialysis and so on also constitute a particularly difficult group.
Consequently, several modified procedures-the use of proximal arm veins, for example-have been designed for creating AVF in the patients who lack suitable veins at the forearm. AVF created at or near the cubital fossa amounted to about 10% of 288 new cases treated at our facility in the past 5 years; and 1.6% in 1988, 1.8% in 1989, 10.4% in 1990, 16.4% in 1991 and 19.4% in 1992. Recently the number has clearly been increasing. In this regard, AVF created at or near the cubital fossa in our 66 cases were evaluated retrospectively.
It is desirable for us to choose a method in which the median cubital vein, cephalic and basilic veins of the upper arm can be punctured but since available veins for AVF at or near the cubital fossa vary from case to case, we had to employ several different operative methods, which were roughly classified into 5 types. The artery used for the anastomosis was the radial or brachial artery. It is crucial for venous networks and deep branches of the vein used for the anastomosis to be ligated as extensively as possible in order to secure the shunted blood flow.
There were no early failures and only 14 late failures.
The high patency rate and minimal postoperative complications were considered acceptable in these otherwise difficult patients.
