Primary success of bifurcated vein patch arteriovenous fistula and Brescia-Cimino methods
Amir Mohsen Jalayifar
Mohammad Reza Keramati
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Introduction. For continuous hemodialysis, an appropriate vascular access, mostly through an arteriovenous fistula (AVF), is crucial. The Brescia-Cimino (BC) method is a common surgical method for AVF creation. However, this method is sometimes not possible, due to a small venous diameter or its wide distance from the artery. We evaluated the success rate of bifurcated vein patch (BVP) technique as an alternative method to BC for AVF placement in hemodialysis patients. Materials and Methods. Candidates for AVF vascular access for hemodialysis were assigned into 2 groups of 50 patients, and AVF was placed using the BC method in one group and the BVP method in the other group. Immediate AVF thrill after the operation, first-day postoperation thrill, weighting period, and nursing staff satisfaction for hemodialysis were compared between the BC and BVP methods. Results. Although the weighting period in the BVP group was longer than that in the BC group, other parameters were similar between the two groups. The AVF thrill intensity after the operation was good to excellent in 87% of the cases with the BC method and good in 95% of those with BVP. Satisfaction of dialysis nursing staff during hemodialysis was reported as 87% good and 4% average in the BC group and 75% good and 20% average in the BVP group. Conclusions. Bifurcated vein patch can be an appropriate alternative technique for cases in which the commonly used BC method is not possible for AVF placement.