Cardiovascular Journal of Africa: Vol 26 No 1 (January/February 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015

AFRICA

U-vein compressor improves early haemodynamic

outcomes in radiocephalic arterio-venous fistulae in

under 2-mm superficial veins

Mustafa Seren, Omer Faruk Cicek, Mustafa Cuneyt Cicek, Ali Umit Yener, Mahmut Ula

Muharrem Tola, Alper Uzun

Abstract

Aim:

In this study, we sought to determine the early post-

operative results of arterio-venous fistulae (AVF) created by

U-vein compressors with veins between 1.5 and 2 mm in size.

Methods:

Pre-operative venous mapping was done. The fistula

tract was marked at 0-, 4-, 8- and 12-cm points; 0 cm was

the estimated point where the anastomosis would be done.

With Doppler ultrasonography, transverse diameters in the

estimated fistula tract were measured at the 0-, 4-, 8- and

12-cm points. A superficial vein that would be used as the

fistula tract was dilated using U-vein compressors. In the

first postoperative hour, the flow in the anastomosis, and the

transverse diameter of the fistula tract at the 0-, 4-, 8- and

12-cm points were measured by Doppler ultrasonography.

Results:

Forty patients were included in the study. U-vein

compressors were used for 20 patients. Postoperative expan-

sion of vein diameters and postoperative flow velocities were

found to be statistically significantly different in patients

where a U-vein compressor had been used (

0.001).

Conclusion:

We present a technique to dilate veins that

are between 1.5 and 2 mm in diameter, which are gener-

ally accepted as poor vessels to create radiocephalic arterio-

venous fistulae.

Keywords:

arterio-venous fistula, vein diameter, flow, maturation

Submitted 11/6/14, accepted 22/1/15

Cardiovasc J Afr

2015;

: 41–44

www.cvja.co.za

DOI: 10.5830/CVJA-2015-008

The radiocephalic arterio-venous fistula (RCAVF) has remained

the access point for maintenance haemodialysis because of its

low incidence of complications and high long-term patency rate.

Distal radial-cephalic anastomosis just above the wrist is still

the best site for an arterio-venous fistula (AVF). This provides

a relatively long, straight cephalic vein for catheter insertion. It

also leaves more proximal sites for future use should the radial-

cephalic fistula fail.

A ‘failure-to-mature’ AVF is caused by intrinsically poor

native vessels. Poor native vessels relate to the use of a suboptimal

artery or vein to create the AVF.

Methods

Between January 2010 and April 2012, 40 normotensive patients

(mean age 56.8 years, range 47–69), 22 males and 18 females,

who underwent RCAVF (20 patients by standard technique, 20

by modified technique) were included in this study. The following

inclusion criteria were considered before access placement: (1)

the non-dominant arm should be selected (if possible), (2) the

access should be placed distally in the forearm, (3) the selected

veins in the forearm should have a long segment to allow for

variation in puncture sites and should have a diameter between

1.5 and 2 mm. Exclusion criteria were: (1) atherosclerotic or

calcific arteries, (2) redo operations, (3) hypotensive patients.

Pre-operatively, venous mapping was done on all patients.

The fistula tract was marked at 0-, 4-, 8- and 12-cm points (Fig.

1); 0 cm was the estimated point where the anastomosis would

be done. With Doppler ultrasonography, the arterial and venous

systems were examined and transverse diameters were measured

at the 0-, 4-, 8- and 12-cm points.

All operations were done under local anaesthesia. The

cephalic vein was dissected surgically and freed in the distal

forearm. Then distal end was ligated with a silk suture. An

intravenous catheter was introduced through the proximal end

of the vein and 2 500 IU of diluted heparin was transfused into

the vein. For the standard technique (20 patients), a 10–12-mm

arteriotomy was done in the radial artery and the cephalic vein

was anastomosed end to side to the radial artery.

In the modified technique (20 patients), we used U-vein

compressors manufactured from stainless steel, 3 cm in width

and 5, 10 and 15 cm in length (Fig. 2). Here, a superficial vein

that would be used as the fistula tract was dilated with the

U-vein compressors by injecting a saline solution just after the

intravenous catheter was introduced through the proximal end

of the vein (Fig. 3). All sizes of U-vein compressors were used

successively to dilate the vein gradually. The U-vein compressors

occluded side branches and proximal segments of the cephalic

vein externally. A 10–12-mm arteriotomy was placed in the radial

Department of Cardiovascular Surgery, Diskapi Yildirim

Beyazit Education and Research Hospital, Ankara, Turkey

Mustafa Seren, MD

Department of Cardiovascular Surgery, Turkiye Yuksek

Ihtisas Education and Research Hospital, Ankara, Turkey

Omer Faruk Cicek, MD,

farux@hotmail.com

Mustafa Cuneyt Cicek, MD

Ali Umit Yener, MD

Mahmut Ula

, MD

Department of Radiology, Turkiye Yuksek Ihtisas Education

and Research Hospital, Ankara, Turkey

Muharrem Tola, MD

Department of Cardiovascular Surgery, Ankara Education

and Research Hospital, Ankara, Turkey

Alper Uzun, MD