Surgical Exploitation of Venous Interconnections in Upper Limb for Creation of Arteriovenous Vascular Access for Hemodialysis

Aim: This article describes our experience of Arterio Venous (AV) vascular access creation for hemodialysis (HD) and its outcomes. Results: A total of 107 AV vascular accesses were created in 102 patients from September 2014 to December 2015. Mean follow-up duration was 12 months. The preferred hand was left in 73 (68.22%) patients compared to the right hand 34 (31.77%). Cephalic vein was used in 63 (58.88%) patients, median basilic or antecubital vein in 30 (28.04%) cases, median vein of forearm in 3 (2.80%) cases, saphenous vein in 3 (2.80%), accessory cephalic vein 2 (1.87%) and AV graft in 6 (5.61%) patients. End (vein) to side (artery) anastamosis was done in 39 (36.45%) cases and side to side anastamosis was done in 68 (63.55%) cases. Complications include distal edema in 8 (7.48%) patients, seroma in 2 (1.87%), hematoma in 2 (1.87%), surgical site infection in 2(1.87%), aneurysm in 4 (3.74%) and skin necrosis in 1 (0.93%) patient. Primary failure occurred in 9 (8.41%) patients due to thrombosis and non maturation and secondary failure due to thrombosis in 6 (5.61%) patients. Conclusion: Venous interconnections of the upper limb provides vascular surgeon an opportunity for successful construction of native Arteriovenous Fistula (AVF) when conventional sites were exhausted.