Background. Brachial Basilic (BB) fistulae are a form of vascular access for patients requiring dialysis. They are indicated when the cephalic vein is unsuitable for use. This fistula can be created with either a single stage or a two stage procedure.
What is a Brachiobasilic transposition?
Brachiobasilic transposition fistulae were created for patients in end stage renal failure in whom haemodialysis was being considered. These were either patients in whom previous vascular access had failed, or in whom alternative vascular access such as radiocephalic or brachiocephalic fistula were not possible.
What is transposed Brachiobasilic fistula?
Transposed brachiobasilic fistulas provide cumulative patency equivalent to upper arm grafts and brachiocephalic fistulas. They are less likely to thrombose and become infected than upper arm grafts.
What is a brachiocephalic fistula for?
Construction of a Cimino-Brescia radiocephalic fistula is the current method of choice for vascular access in most patients on chronic hemodialysis. However, previous vascular access procedures, cephalic vein thrombosis or intrinsic arterial disease may render this procedure impracticable.
What is a transposed fistula?
The arteriovenous fistula transposition is based on a first-stage proximal radial artery to median cubital vein arteriovenous fistula. Transposed brachial veins were elevated and positioned anteriorly to the incision to avoid repeated needle access through the surgical scar (Fig 2).
What is Superficialization of AV fistula?
‘Superficialization’ or ‘fistula elevation’ involves an incision from the wrist to the proximal forearm in radiocephalic fistulas, and from the antecubital fossa to the proximal upper arm in brachiocephalic or brachiobasilic fistulas.
What is fistula creation?
An AV fistula is a surgical connection made between an artery and a vein, created by a vascular specialist. An AV fistula is typically located in your arm, however, if necessary it can be placed in the leg.
Who does fistula surgery?
The surgery is performed by a colon and rectal surgeon. The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged. Fistulas in which there is no or little sphincter muscle involved are treated with a fistulotomy.
What is a DRIL procedure?
The distal revascularization and interval ligation (DRIL) procedure is a surgical procedure, which has been used to treat patients with hand ischemia secondary to arterial “steal” from dialysis accesses.
What is the most common complication of AV fistulas?
Heart failure. This is the most serious complication of large arteriovenous fistulas. Blood flows more quickly through an arteriovenous fistula than it does through normal blood vessels. As a result, your heart pumps harder to make up for the increase in blood flow.
What is a Fistuloplasty?
What is a fistuloplasty? An AV (arteriovenous) fistula is the best means of access to the blood stream for long-term heamodialysis. It is created by connecting an artery to a vein, usually in your wrist or upper arm, and it helps to transfer blood into the dialysis machine and back again during haemodialysis.
What is a Radiocephalic fistula?
The radiocephalic fistula (Fig. 3) is a forearm fis- tula created by anastomosing the side of a ra- dial artery to the end of a cephalic vein. It is also referred to as the Brescia-Cimino fistula.
What is the most common site of stenosis in a brachiocephalic fistula?
The most common cause for a brachiocephalic fistula to fail is due to a stenosis in the cephalic arch. If neither a radiocephalic nor a brachiocephalic fistula are possible, KDOQI guidelines recommend consideration of placement of a brachial artery –to-transposed basilic vein fistula.
Where is the brachiocephalic vein?
The brachiocephalic veins lie in close proximately to the muscles of the inferior neck. The confluence of the subclavian vein and internal jugular vein, which form the brachiocephalic veins, are found on the medial border of the scalenus anterior muscle.
How long does fistula last?
Depending on the person, it can take several weeks to several months for an AV fistula to heal and mature. In the United States, the time from AV fistula creation until first use averages 133 days, or approximately 4 months. As it heals and matures, the appearance of your fistula will probably change.
What is the transposition?
1a : an act, process, or instance of transposing or being transposed. b : the transfer of a segment of DNA from one site to another in the genome. 2a : the transfer of any term of an equation from one side over to the other side with a corresponding change of the sign.
What is left basilic vein transposition?
The conventional surgical technique of basilic vein transposition consists of dissection and mobilizing the basilic vein at the medial side of the upper arm. After dissection, the basilic vein is transposed to a subcutaneous tunnel on the anterior surface of the arm and anastomosed to the brachial artery [10,11].
What is Second Stage basilic vein transposition?
In two-stage procedures, the basilic vein is mobilised through a transverse antecubital fossa incision followed by creation of the fistula. Following a period of 4–6 weeks necessary for maturation, the second stage involves mobilisation of the basilic vein through two longitudinal skip incisions (Fig.
Which type of AV access normally needs Superficialization?
Once the arteriovenous fistula is created, maturation is necessary prior to access attempts. In obese patients or those with deep veins, superficialization is often necessary to facilitate the repeated cannulation required for dialysis.
How many types of AV fistula are there?
There are 3 basic types of AVF dialysis: Radial Cephalic fistula. Brachial Cephalic.
What are the indications for AV fistula placement?
INDICATIONS. The most common indication for creation of an arteriovenous (AV) fistula is renal failure requiring chronic hemodialysis. It is preferable to create a native fistula, although prosthetic material may be needed if a suitable vein is not available.
How do you get a fistula?
How serious is a fistula?
How serious is a fistula? Fistulas can cause a lot of discomfort, and if left untreated, may cause serious complications. Some fistulas can cause a bacteria infection, which may result in sepsis, a dangerous condition that can lead to low blood pressure, organ damage or even death.
Can a fistula burst?
A rupture can happen any time with a fistula or graft.
What does fistula look like?
An anorectal or anal fistula is an abnormal, infected, tunnel-like passageway that forms from an infected anal gland. Sometimes an anal fistula works its way from an internal gland to the outside of the skin surrounding the anus. On the skin, this looks like an open boil.
Is fistula a major surgery?
Fistula surgery may be a minor procedure, but patience is definitely required for the recovery process. You might find that your wound drains for weeks after surgery, as it will be left open to aid healing.
How can I fix my fistula without surgery?
Treatment with fibrin glue is currently the only non-surgical option for anal fistulas. It involves the surgeon injecting a glue into the fistula while you’re under a general anaesthetic. The glue helps seal the fistula and encourages it to heal.
What are the symptoms of steal syndrome?
Hemodialysis access-related hand ischemia or ‘steal syndrome’ causes problems such as hand numbness, pain, coldness and weakness, as well as significantly reduced blood flow/pressure to affected tissues. In extreme cases, it can cause tissue death (gangrene), which may lead to the loss of fingers.
How is steal syndrome treated?
Treatment of steal includes observation of developing symptoms in mild cases. Balloon angioplasty is the appropriate intervention for an arterial stenosis. At least three distinct surgical corrective procedures exist to counteract the pathophysiology of steal.
What is a HeRO graft?
The HeRO Graft is a hemodialysis access graft for patients who are failing fistulas or grafts or are catheter-dependent due to the blockage of veins leading to the heart.
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