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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
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated