Subcutaneous brachial vein arteriovenous fistula for chronic hemodialysis

Abstract While the subcutaneous arteriovenous fistula is the ideal method for creating vascular access for chronic hemodialysis, it is not suitable for all patients. Other methods such as polytetrafluoroethylene grafts have proven satisfactory but have been fraught with problems in some cases. In these situations, we have employed the brachial vein arteriovenous fistula as a means of providing continuing vascular access. The brachial vein is dissected free from surrounding structures in the upper arm and anastomosed to the distal brachial artery in end‐to‐side fashion. The arterialized vein is then placed in the subcutaneous position for easy access. We have performed this procedure in 12 patients. All have had previous access problems. Follow‐up has extended from 1 to 34 months. There have been 3 failures and 7 complications. Nine patients have maintained patency of their fistulas through the follow‐up period, until transplanted, or until death. We feel that the brachial vein fistula is a reasonable alternative in patients who have encountered problems with standard wrist arteriovenous fistulas or with prosthetic grafts.