A Technic for Closure of Arteriovenous Fistulas Rino Munda, MD, Cincinnati, Ohio J. Wesley Alexander, MD, ScD, Cincinnati,
Ohio
Arteriovenous fistulas are usually made to provide vascular access for the patient on chronic hemodialysis and more recently for continuous parenteral hyperalimentation. A side-to-side arteriovenous anastomosis, between the cephalic vein and radial artery or at a more proximal level between the brachial artery and antecubital vein, is commonly used. Upon discontinuation of the therapeutic procedure, closure of the fistula is frequently indicated. Preservation of distal arterial perfusion with closure of the fistula is extremely important in patients with brachial fistulas or with vascular disease. Preservation of arteries. for further use is also an important consideration in patients with chronic renal disease treated by transplantation. The procedure is performed with local anesthesia. A proximal tourniquet is placed, but it is not inflated until exposure of the vessels. (a) The old incision is opened. (b) The fistula is exposed. (c) The vein is tied off proximally and distal to the fistula. After doing this, the extremity is elevated and the tourniquet inflated. (d) The vein is transected at either end and opened longitudinally opposite the fistula. (Figure 1.) (e) The excess of tissue is trimmed off. (f) The vein is closed with a continuous 6-O Prolene suture. Enough tissue should be left to leave a uniform arterial lumen. Narrowing or dilatation should be avoided. (g) The artery is shown with the autologous venous patch. The tourniquet is deflated. (Figure 2.)
Artery
b.
d.
Figure 1. (a) The old incision is opened. (b) The fisfuia is exposed. (c) The vein is tied off proximal and distal to the fistuia. (d) The vein is transected at either end and opened longitudinally opposite to the fistuia.
Summary
A technic for closure of arteriovenous fistulas is presented. Preservation of arteries for distal perfusion and further use is an important consideration in chronic renal transplant patients with chronic renal disease treated by transplantation. Reference 1. Brescia JM, Cimino JE, Appel K, Henwick BJ: Chronic hemodialysis using created arteriovenous fistula. N Eng/J Med 275: 1089, 1966. From the Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio. Reprint requests should be addressed to Rino Munda, MD. Assistant Professor of Surgery, University of Cincinnati Medical Center, Surgical Research Unit, 234 Goodman Street, Cincinnati, Ohio 45267.
676
Figure 2. (e) The excess of tissue is trimmed off. (f) The vein is closed with continuous 6-O Proiene suture. (g) The artery is shown with autoiogous vein patch.
The American Journal of Surgery
Ohio
Arteriovenous fistulas are usually made to provide vascular access for the patient on chronic hemodialysis and more recently for continuous parenteral hyperalimentation. A side-to-side arteriovenous anastomosis, between the cephalic vein and radial artery or at a more proximal level between the brachial artery and antecubital vein, is commonly used. Upon discontinuation of the therapeutic procedure, closure of the fistula is frequently indicated. Preservation of distal arterial perfusion with closure of the fistula is extremely important in patients with brachial fistulas or with vascular disease. Preservation of arteries. for further use is also an important consideration in patients with chronic renal disease treated by transplantation. The procedure is performed with local anesthesia. A proximal tourniquet is placed, but it is not inflated until exposure of the vessels. (a) The old incision is opened. (b) The fistula is exposed. (c) The vein is tied off proximally and distal to the fistula. After doing this, the extremity is elevated and the tourniquet inflated. (d) The vein is transected at either end and opened longitudinally opposite the fistula. (Figure 1.) (e) The excess of tissue is trimmed off. (f) The vein is closed with a continuous 6-O Prolene suture. Enough tissue should be left to leave a uniform arterial lumen. Narrowing or dilatation should be avoided. (g) The artery is shown with the autologous venous patch. The tourniquet is deflated. (Figure 2.)
Artery
b.
d.
Figure 1. (a) The old incision is opened. (b) The fisfuia is exposed. (c) The vein is tied off proximal and distal to the fistuia. (d) The vein is transected at either end and opened longitudinally opposite to the fistuia.
Summary
A technic for closure of arteriovenous fistulas is presented. Preservation of arteries for distal perfusion and further use is an important consideration in chronic renal transplant patients with chronic renal disease treated by transplantation. Reference 1. Brescia JM, Cimino JE, Appel K, Henwick BJ: Chronic hemodialysis using created arteriovenous fistula. N Eng/J Med 275: 1089, 1966. From the Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio. Reprint requests should be addressed to Rino Munda, MD. Assistant Professor of Surgery, University of Cincinnati Medical Center, Surgical Research Unit, 234 Goodman Street, Cincinnati, Ohio 45267.
676
Figure 2. (e) The excess of tissue is trimmed off. (f) The vein is closed with continuous 6-O Proiene suture. (g) The artery is shown with autoiogous vein patch.
The American Journal of Surgery
