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Superficialization of brachial artery as effective alternative vascular access.
[heparin-induced thrombocytopenia]
The
Japanese
Society
for
Dialysis
Therapy
recommends
superficialization
of
the
brachial
artery
(
BA
)
as
an
alternative
vascular
access
(
VA
)
technique
in
patients
for
whom
a
conventional
internal
shunt
(
arteriovenous
fistula
[
AVF
]
or
arteriovenous
graft
)
can
not
be
created
.
Although
2
%
to
3
%
of
Japanese
hemodialysis
patients
undergo
this
procedure
,
it
is
not
well
recognized
worldwide
.
We
report
here
our
experience
with
the
procedure
,
as
well
as
indications
,
durability
,
and
morbidity
.
The
technique
involves
exposure
of
the
BA
and
ligation
of
the
side
branches
,
then
fixing
it
beneath
the
skin
at
the
upper
arm
.
Cannulation
of
the
BA
is
performed
2
weeks
or
more
after
surgery
,
and
it
is
used
as
an
outflow
route
,
with
any
vein
in
an
upper
extremity
utilized
for
blood
return
,
including
the
hand
if
sites
in
the
arm
are
not
accessible
.
We
retrospectively
reviewed
our
cases
of
superficialization
of
the
BA
for
VA
.
F
rom
2005
through
2008
,
a
total
of
24
patients
(
11
females
[
46
%
]
;
average
age
,
69
years
[
range
,
39
-
84
years
]
)
underwent
superficialization
of
the
BA
,
of
whom
eight
(
33
%
)
had
diabetes
.
The
indications
were
(
1
)
impaired
cardiac
function
(
n
=
13
)
;
(
2
)
no
other
prospect
for
AVF
or
patient
refused
prosthetic
graft
implantation
(
n
=
5
)
;
(
3
)
severe
upper
extremity
arterial
disease
or
ischemic
steal
syndrome
requiring
AVF
closure
(
n
=
3
)
;
(
4
)
venous
hypertension
with
central
vein
occlusion
(
n
=
2
)
;
and
(
5
)
repeated
AVF
thrombosis
due
to
heparin-induced
thrombocytopenia
(
n
=
1
)
.
The
mean
follow-up
period
was
28
months
.
Serious
complications
were
seen
in
one
patient
with
an
infected
pseudoaneurysm
formation
associated
with
a
BA
puncture
,
which
necessitated
BA
ligation
,
while
two
patients
required
an
aneurysmectomy
with
reconstruction
and
one
had
occlusion
of
the
superficialized
BA
,
though
no
clinical
symptoms
of
hand
ischemia
developed
.
We
also
had
difficulty
finding
a
vein
for
blood
return
in
five
patients
.
The
rate
of
superficialized
BA
patency
as
a
functioning
VA
was
95
%
and
66
%
at
1
and
3
years
,
respectively
.
Superficialization
of
the
BA
was
found
to
be
a
simple
and
safe
technique
,
with
acceptable
durability
and
complication
rate
in
selected
Japanese
hemodialysis
patients
.
We
consider
that
this
shuntless
VA
permits
adequate
blood
flow
and
has
theoretical
advantages
for
some
patients
,
particularly
those
with
impaired
cardiac
function
,
though
the
availability
of
a
return
vein
is
a
prerequisite
for
a
functioning
VA
.
Diseases
Validation
Diseases presenting
"including the hand if sites in the arm are not accessible"
symptom
heparin-induced thrombocytopenia
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