Abstract
As the number of patients on hemodialysis increases, there will also be an increase in the number of patients with inadequate superficial veins for the creation of an autogenous arteriovenous fistula (AVF). In those patients, medical devices such as vascular prostheses or tunneled-cuffed catheters are necessary to maintain dialysis access. However, these devices are frequently associated with bacterial infection. We recently encountered a dialysis patient who underwent tunneled-cuffed catheter insertion because of the lack of usable superficial veins for autogenous access, and this patient subsequently developed catheter-related Staphylococcus aureus bacteremia with multiple metastatic infections. Despite immediate removal of the catheter, the infection persisted over an extended period, which was a condition precluding the further use of catheters or other prosthetic materials. To handle this situation, we utilized the deep brachial vein to construct an autogenous AVF. After ligating numerous branches, the vein was anastomosed to the brachial artery and then transposed to the subcutaneous space. The newly constructed autogenous AVF, which successfully kept the patient free from foreign materials, greatly contributed to the relief of persistent infection. Although the brachial vein is rarely used for AVF creation, we suggest that it can serve as an option to create an alternative AVF in a patient with inadequate superficial veins.
Similar content being viewed by others
References
Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis. 2006;13:199–204.
Keuter XH, De Smet AA, Kessels AG, van der Sande FM, Welten RJ, Tordoir JH. A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg. 2008;47:395–401.
Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int. 2002;61:305–16.
Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg. 2003;38:1005–11.
Bazan HA, Schanzer H. Transposition of the brachial vein: a new source for autologous arteriovenous fistulas. J Vasc Surg. 2004;40:184–6.
Angle N, Chandra A. The two-stage brachial artery–brachial vein autogenous fistula for hemodialysis: an alternative autogenous option for hemodialysis access. J Vasc Surg. 2005;42:806–10.
Greenberg JI, May S, Suliman A, Angle N. The brachial artery–brachial vein fistula: expanding the possibilities for autogenous fistulae. J Vasc Surg. 2008;48:1245–50.
Dorobantu LF, Stiru O, Iliescu VA, Novelli E. The brachio-brachial arteriovenous fistula: a new method in patients without a superficial venous system in the upper limb. J Vasc Access. 2006;7:87–9.
Dix FP, Khan Y, Al-Khaffaf H. The brachial artery-basilic vein arterio-venous fistula in vascular access for haemodialysis: a review paper. Eur J Vasc Endovasc Surg. 2006;31:70–9.
Pierre-Paul D, Williams S, Lee T, Gahtan V. Saphenous vein loop to femoral artery arteriovenous fistula: a practical alternative. Ann Vasc Surg. 2004;18:223–7.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sato, Y., Miyamoto, M., Yazawa, M. et al. Brachial–brachial autogenous arteriovenous fistula in a dialysis patient with Staphylococcus aureus bacteremia. J Artif Organs 13, 51–53 (2010). https://doi.org/10.1007/s10047-010-0485-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10047-010-0485-0