Anatomical traps for arteriovenous fistula creation
Abstract
Background: The risk of complications in undisclosed vascular variability appears relatively likely. Therefore, it is important to assess the probability of encountering anatomical-topographic variability in the venous system of the upper limb. The catalogue of patterns of the upper limb venous system seems to be unlimited and should therefore be constantly updated. The aim of the study was to explore the venous system of upper extremity and discuss some problems that would be encountered with the formation of an arteriovenous fistula. Results: In 17 (85%) explored upper limbs, the venous system showed a pattern similar to the reports already described. But in (15%) 3 of them, the venous system showed certain differences in relation to the accepted anatomical textbooks. Especially in one of them the anatomical variant of basilic and cephalic vein contrasted distinctly with the other veins. Based on the revealed anomalies, a statistical analysis of the probability of occurrence of any anatomical variant and the risk of complications associated with fistula creation was conducted. Even on such small group an assessed probability of anatomical variability of the upper limb venous system was statistically significant at p < 0.0244 (odds ratio 0.0828; 95% confidence interval 0.0095–0.7252). Conclusions: The probability of any anatomical-topographic variability in the venous system of the upper limb should be considered as statistically significant. Only intense anatomical dissections would undoubtedly help to avoid some anatomical traps and then minimise some complications in the creation of arteriovenous fistulas.
Keywords: veinsupper limbanatomy variantarteriovenous fistulacomplications
References
- Al-Jaishi AA, Liu AR, Lok CE, et al. Complications of the Arteriovenous Fistula: A Systematic Review. J Am Soc Nephrol. 2017; 28(6): 1839–1850.
- Altıparmak B, Korkmaz Toker M, Uysal Aİ, et al. Double axillary vein variation diagnosed with ultrasound guidance during infraclavicular nerve block intervention. BMJ Case Rep. 2019; 12(1).
- Anaya-Ayala JE, Younes HK, Kaiser CL, et al. Prevalence of variant brachial-basilic vein anatomy and implications for vascular access planning. J Vasc Surg. 2011; 53(3): 720–724.
- Astor BC, Eustace JA, Powe NR, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol. 2005; 16(5): 1449–1455.
- Brescia MJ, Cimino JE, Appell K, et al. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966; 275(20): 1089–1092.
- Fontaine C. Some help for literature study in anatomical variation reports. Surg Radiol Anat. 2001; 23(5): 293–294.
- Griffioen FMM, Drukker J, Hoogland PVJM, et al. General plan anatomy. Objectives of the teaching of anatomy/embryology in medical curricula in the netherlands. Eur J Morphol. 1999; 37(4-5): 288–325.
- Jones DG, Dias GJ, Mercer S, et al. Clinical anatomy research in a research-driven anatomy department. Clin Anat. 2002; 15(3): 228–232.
- Kaiser CL, Anaya-Ayala JE, Ismail N, et al. Unrecognized basilic vein variation leading to complication during basilic vein transposition arteriovenous fistula creation: case report and implications for access planning. Eur J Vasc Endovasc Surg. 2010; 39(5): 627–629.
- Lee H, Lee SH, Kim SJ, et al. The clinical anatomy of the cephalic vein in the deltopectoral triangle. Folia Morphol. 2008; 67: 72–77.
- Lemson MS, Tordoir JH, Daemen MJ, et al. Intimal hyperplasia in vascular grafts. Eur J Vasc Endovasc Surg. 2000; 19(4): 336–350.
- Miller A, Hölzenbein TJ, Gottlieb MN, et al. Strategies to increase the use of autogenous arteriovenous fistula in end-stage renal disease. Ann Vasc Surg. 1997; 11(4): 397–405.
- Quinton W, Dillard D, Scribner BH, et al. Cannulation of blood vessels for prolonged hemodialysis. Trans Am Soc Artif Intern Organs. 1960; 6(1): 104–113.
- Sadeghi A, Setayesh Mehr M, Esfandiari E, et al. Variation of the cephalic and basilic veins: A case report. J Cardiovasc Thorac Res. 2017; 9(4): 232–234.
- Sandhu NPS, Sidhu DS. Mid-arm approach to basilic and cephalic vein cannulation using ultrasound guidance. Br J Anaesth. 2004; 93(2): 292–294.
- Sanudo JR, Vazquez R, Puerta J. Meaning and clinical interest of the anatomical variations in the 21st century. Eur J Anat. 2003; 7(S1): 1–3.
- Tellis VA, Veith FJ, Soberman RJ, et al. Internal arteriovenous fistula for hemodialysis. Surg Gynecol Obstet. 1971; 132(5): 866–870.
- Wijeyaratne SM, Kannangara L. Safety and efficacy of electrospun polycarbonate-urethane vascular graft for early hemodialysis access: first clinical results in man. J Vasc Access. 2011; 12(1): 28–35.
