Brachiocephalic jump graft fistula: An alternative for dialysis use of elbow crease veins

Elbow crease fistula can be an alternative for autologous vascular access. Either brachiocephalic or brachiobasilic fistulas could be chosen according to the venous anatomy at the elbow crease. When a median antecubital vein is not present, the cephalic vein is usually too far away from the brachial artery. Thus, a end to-side fistula must usually be performed after an ext ensive dissection of the distal part of the vein. In this way, only the pro ximal cephalic vein can be used for dialysis, To overcome this drawback, a brachiocephalic jump graft fistula was designed, A short segment of polytet rafluoroethylene graft, 6 mm in diameter, is tunneled under the skin and an astomosed to the artery acid vein through two short longitudinal skin incis ions, From 1981 to 1995, 222 brachiocephalic graft jump fistulas were const ructed. The mean age of the patients was 56.1 years, 20% had diabetic nephr opathy, and 61.7% had a previously failed angioaccess, Follow-up was obtain ed in 92.4% of the patients, and overall follow-up was 6,665 fistula-months , Early failure was observed in 4% of the cases. The complication rate was two episodes per 100 fistula months of follow-up. Primary patency rates (ev ent-free patency) were 85%, 67%, 48%, and 34% at 1, 3, 5, and 7 years. Seco ndary patency rates (overall patency) were 85%, 72%, 56%, and 43% at 1,3, 5 , and 7 years, There were no differences between primary and secondary curv es. Brachiocephalic graft jump fistula is a reliable technical variation of elbow crease fistulas for dialysis and can be another alternative to graft access when the cephalic vein is dominant at the elbow crease, (C) 1999 by the National Kidney Foundation, Inc.