Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.190077
Jornal Vascular Brasileiro
Original Article

Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

Brachial vein transposition: an alternative to hemodialysis arteriovenous graft

Guilherme de Castro-Santos; Alberto Gualter Salles; Giuliano Silva dos Anjos; Ricardo Jayme Procópio; Túlio Pinho Navarro

Downloads: 0
Views: 20

Resumo

Resumo: Contexto: Atualmente, observa-se um esforço mundial para aumento do número de acessos autógenos para hemodiálise.

Objetivos: Avaliar a perviedade e as complicações da transposição da veia braquial em comparação aos outros acessos autógenos para hemodiálise.

Métodos: Avaliação retrospectiva de 43 pacientes, com 45 procedimentos. Os pacientes que não apresentaram veias do sistema venoso superficial adequadas ao Duplex Scan pré-operatório foram submetidos à transposição da veia braquial. Esses procedimentos foram divididos em dois grupos: A: uso da veia braquial, n = 10. B: demais acessos, n = 35.

Resultados: Não houve diferença estatística entre os grupos no que se refere à idade, diabetes, hipertensão arterial sistêmica, dislipidemias, arteriopatias, neoplasias, estágio da doença renal, diâmetro da artéria doadora e da veia receptora, pressão arterial sistólica no membro operado, isquemia pós-operatória, formação de hematoma e infecção. Não houve diferença quanto à perviedade aos 7 dias A: 80% vs. B: 90%, p = 0,6; aos 30 dias A: 80% vs. B: 86%, p = 0,6; e aos 60 dias A: 60% vs. B: 80%, p = 0,22. Houve diferença entre os grupos quanto ao número de fístulas prévias A: 1,0 ± 0,44 vs. B: 0,6 ± 0,3, p = 0,04; e quanto ao edema em membro superior A: 20% vs. B: 0%, p = 0,04. A veia doadora menor que 3 mm esteve associada ao maior risco de oclusão precoce (RR = 8, p = 0,0125). Nesse período, não houve nenhum procedimento com o uso de prótese sintética.

Conclusões: A veia braquial transposta é uma alternativa à prótese sintética.

Palavras-chave

veia braquial, prótese, fistula first, artéria braquial, aceso para hemodiálise, fístula arteriovenosa

Abstract

Abstract: Background: There is currently a worldwide effort to increase the options for autogenous hemodialysis access.

Objectives: To evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses.

Methods: A retrospective evaluation of 43 patients and 45 procedures. Patients who did not have adequate superficial veins according to duplex scanning were allocated to brachial vein transposition. The sample was thus divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35.

Results: There were no statistical differences between the two groups in terms of age diabetes, systemic arterial hypertension, dyslipidemias, arteriopathies, neoplasms, kidney disease stage, donor artery diameter, recipient vein diameter, systolic blood pressure in the operated limb, postoperative ischemia, hematoma, or infection. There were no statistical differences in terms of patency on day 7: A 80% vs. B 90% p=0.6, on day 30: A 80% vs. B 86% p=0.6, or on day 60: A 60% vs. B 80% p=0.22. There were statistical differences between the groups for number of previous fistulae A 1.0 ± 0.44 vs. B 0.6 ± 0.3 p = 0.04 and upper limb edema A: 20% x B 0% p = 0.04. A vein with diameter of less than 3 mm was associated with an increased risk of early occlusion (RR = 8 p = 0.0125). During the study period there were no procedures using grafts.

Conclusions: Transposition of brachial vein is an alternative to arteriovenous graft.
 

Keywords

brachial vein, graft, fistula first, brachial artery, hemodialysis access, arteriovenous fistula

References

Pham XD, Kim JJ, Ihenachor EJ, et al. Comparison of brachial artery-brachial vein arteriovenous fistulas with av grafts in patients with poor superficial venous anatomy. J Vasc Surg. 2017;65(2):444-51. http://dx.doi.org/10.1016/j.jvs.2016.09.037. PMid:27986484.

Morisson B, Araújo AL, Harduin LO, et al. A pilot study comparing bovine mesenteric artery and expanded polytetrafluoroethylene grafts as non-autogenous hemodialysis options. J Vasc Bras. 2018;17(4):303-9. http://dx.doi.org/10.1590/1677-5449.007117. PMid:30787948.

National Kidney Foundation. 2006 updates clinical practice guidelines and recommendations. New York: KDOQI [cited 2019 Maio 26]. Available from: https://www.kidney.org/sites/default/files/docs/12-50-0210_jag_dcp_guidelines-pd_oct06_sectionb_ofc.pdf

Sesso RC, Lopes AA, Thomé FS, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2016. J Bras Nefrol. 2017;39(3):261-6. http://dx.doi.org/10.5935/0101-2800.20170049. PMid:29044335.

Perera GB, Mueller MP, Kubaska SM, Wilson SE, Lawrence PF, Fujitani RM. Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg. 2004;18(1):66-73. http://dx.doi.org/10.1007/s10016-003-0094-y. PMid:14727162.

Roy-Chaudhury P, Sukhatme VP, Cheung AK. Cheung hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol. 2006;17(4):1112-27. http://dx.doi.org/10.1681/ASN.2005050615. PMid:16565259.

Koontz PG Jr, Helling TS. Subcutaneous brachial vein arteriove- nous fistula for chronic hemodialysis. World J Surg. 1983;7(5):672-4. http://dx.doi.org/10.1007/BF01655353. PMid:6636812.

Bazan HA, Schanzer H. Transposition of the brachial vein: a new source for autologous arteriovenous fistulas. J Vasc Surg. 2004;40(1):184-6. http://dx.doi.org/10.1016/j.jvs.2004.03.044. PMid:15218484.

Karam L, Rawa M, Shoenfeld R, Bourquelot P. Brachial vein transposition is a promising ultimate upper limb autologous arteriovenous angioaccess despite its many pitfalls. J Vasc Surg. 2017;67(1):236-43. http://dx.doi.org/10.1016/j.jvs.2017.05.120. PMid:28733096.

Casey K, Tonnessen BH, Mannava K, Noll R, Money SR, Sternbergh WC 3rd. Brachial versus basilic vein dialysis fistulas: a comparison of maturation and patency rates. J Vasc Surg. 2008;47(2):402-6. http://dx.doi.org/10.1016/j.jvs.2007.10.029. PMid:18241763.

Center for Medicare & Medicaid Services. Questions and answers. Baltimore: CMS.gov; 2004 [cited novembro de 2019 26]. Available from: https://www.cms.gov/Medicare/End-Stage-Renal-Disease/ESRDQualityImproveInit/downloads/FFFAQs.pdf

Lioupis C, Mistry H, Chandak P, Tyrrell M, Valenti D. Autogenous brachial-brachial fistula for vein access. Haemodynamic factors predicting outcome and 1 year clinical data. Eur J Vasc Endovasc Surg. 2009;38(6):770-6. http://dx.doi.org/10.1016/j.ejvs.2009.08.004. PMid:19758825.

Kotsis T, Moulakakis KG, Mylonas SN, Kalogeropoulos P, Dellis A, Vasdekis S. Brachial artery-brachial vein fistula for hemodialysis: one- or two-stage procedure-a review. Int J Angiol. 2016;25(1):14-9. http://dx.doi.org/10.1055/s-0035-1558465. PMid:26900307.

Lauvao LS, Ihnat DM, Goshima KR, Chavez L, Gruessner AC, Mills JL Sr. Vein diameter is the major predictor of fistula maturation. J Vasc Surg. 2009;49(6):1499-504. http://dx.doi.org/10.1016/j.jvs.2009.02.018. PMid:19497513.

Bashar K, Conlon PJ, Kheirelseid EA, Aherne T, Walsh SR, Leahy A. Arteriovenous fistula in dialysis patients: factors implicated in early and late AVF maturation failure. Surgeon. 2016;14(5):294-300. http://dx.doi.org/10.1016/j.surge.2016.02.001. PMid:26988630.

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(4):806-10. http://dx.doi.org/10.1016/j.jvs.2005.05.045. PMid:16242575.

Elwakeel HA, Saad EM, Elkiran YM, Awad I. Unusual vascular access for hemodialysis: transposed venae comitante of the brachial artery. Ann Vasc Surg. 2007;21(5):560-3. http://dx.doi.org/10.1016/j.avsg.2007.03.026. PMid:17823039.

Jennings WC, Sideman MJ, Taubman KE, Broughan TA. Brachial vein transposition arteriovenous fistulas for hemodialysis access. J Vasc Surg. 2009;50(5):1121-5, discussion 1125-6. http://dx.doi.org/10.1016/j.jvs.2009.07.077. PMid:19782506.

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(2):87-9. http://dx.doi.org/10.1177/112972980600700209.

Torina PJ, Westheimer EF, Schanzer HR. Brachial vein transposition arteriovenous fistula: is it an acceptable option for chronic dialysis vascular access? J Vasc Access. 2008;9(1):39-44. http://dx.doi.org/10.1177/112972980800900107. PMid:18379979.

Vrakas G, Defigueiredo F, Turner S, Jones C, Taylor J, Calder F. A comparison of the outcomes of one-stage and two-stage brachiobasilic arteriovenous fistulas. J Vasc Surg. 2013;58(5):1300-4. http://dx.doi.org/10.1016/j.jvs.2013.05.030. PMid:23810301.
 

5dde68050e8825952a7b23c6 jvb Articles

J Vasc Bras

Share this page
Page Sections