The Brachio-brachial Arteriovenous Fistula: a New Method in Patients Without a Superficial Venous System in the Upper Limb

Purpose: This study aimed to report our experience in the creation of brachio-brachial arteriovenous fistulas (AVFs) in patients without adequate superficial venous circulation at the upper limb.

Methods: A retrospective study of 33 patients, operated on between 2004-2005, in whom we created a brachio-brachial fistula between the brachial artery and the brachial vein. After dissection and adequate mobilization, the brachial vein was anastomized to the brachial artery in an end-to-side fashion. After the maturation period (1 month) the brachial vein was transposed into the subcutaneous tissue.

Results: Thirty-three patients underwent 33 brachio-brachial fistula constructions. Primary patency was achieved in all patients. After 1 month, 27 fistulas (81.8%) were functional. Six patients developed fistula occlusion. The 27 remaining patients had subsequently good fistulas for hemodialysis (HD) afterwards. Discrete edema of the forearm was noted in 12 patients (36%); in one of these patients the edema was extended to the entire arm. No other complications were noted. A follow-up study, extended from 3-26 months (mean 14 +/- 6.6 months), was performed. The overall patency rate of the brachio-brachial fistula at the end of the follow-up was 85.2%.

Conclusions: The brachio-brachial fistula can represent a viable choice in patients with an inadequate superficial venous system in the upper limb.