Brachiobasilic Fistulas Superficialization with Minimal Incisions: A New Approach by Very Good Outcomes

Mohammad Hassani; Seyed Ali Marashi; Peyman Bakhshaei  Shahrebabaki; Mohammadtaghi  Salehian; Katayon Hassanzadeh

doi:10.18502/jimc.v5i1.9580

Mohammad Hassani Department of Vascular and Endovascular Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Seyed Ali Marashi Department of Vascular and Endovascular Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Peyman Bakhshaei Shahrebabaki Department of Vascular and Endovascular Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammadtaghi Salehian Department of Vascular and Endovascular Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Katayon Hassanzadeh Internal Medicine Ward, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v5i1.9580

Keywords: Brachial artery, Basilic vein, Hemodialysis, Minimal incision, Superficialization

Abstract

Background: Failure of cannulation due to the unavailability of deep veins is one of the complicated problems for chronic hemodialysis patients. By using superficialization, the veins with larger caliber and intact intima will be available for continuing the dialysis process. Brachio-Basilic superficialization with Minimal Incision (BBMI) is a proposed method that its patency and results are explored in the current study.

Methods: Thirty hemodialysis patients with two-step superficialization indication were evaluated. For BBMI, first by using sonography, basilic vein pathway was marked and with three small incisions matured basilic vein explored and transected near pervious anastomosis and transposed from new subcutaneous tunneling and re-anastomosed the vein. In a definitive time period up to 6 months, the study variables were evaluated.

Results: There were 11 females and 19 males. The minimum and maximum ages were 29 and 92. Technical success was 100%. After passing several successful dialysis sessions from the superficialized vein, 2 patients (6.7%) encountered unsuccessful cannulation due to thrombosis, and one of thrombosis events was due to hypotension. These cases were whom with the shortest interruption between surgery and dialysis initiation (18 and 25 days; mean±SD=28.63 ±7.36 days). There were no cases of infection and pseudoaneurysm. Furthermore, 1 case (3%) experienced wound dehiscence that managed using proper wound care.

Conclusion: BBMI could be utilized safely with a high patency. This method has the lowest complications. The minimal side effects are affected by predisposing factors that should be clarified precisely in future studies and by gathering more evidence.