الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 105 |  |  |
| | | from | 105 | | |
Abstract
Since the publication of Dialysis Outcomes Quality Initiative (DOQI) guidelines, the use of native veins for the construction of arteriovenous fistulas (AVF) for hemodialysis has been highly recommended rather than prosthetic arteriovenous grafts (AVG). Brescia and associates ~ first described the use of primary arteriovenous fistulas (AFs) in the forearm for use in patients who undergo chronic hemodialysis. Once established, mature Alas have improved patency rates and lower complication and infection rates compared with synthetic bridging grafts.
There is a technique of superficial venous transposition in the forearm used for the formation of an arteriovenous fistula for hemodialysis access. These modifications of the single-incision radiocephalic fistula are designed to increase options for arteriovenous fistulas by using veins and arteries that are suitable for use but are not in immediate proximity.
Methods:
Arteries and veins suitable for a primary arteriovenous fistula were identified and mapped using duplex ultrasound in 30 patients. A longitudinal incision was made directly over the mapped vein beginning at its distal towards the antecubital fossa for a distance about 15 cm and the selected forearm vein was mobilized, angiodilated, and transposed into a subcutaneous tunnel on the volar aspect of the forearm. Before initiation of hemodialysis, duplex ultrasotmd scanning was performed, and the location that was most suitable for cannulation was identified.
Results:
Thrombosis was found in four cases (13.3%) after 3 months of operation. This can be explained by attack of severe hypotension and diabetes. In this study the total number of complication was 4 of 30 cases. No case complicated by primary hemorrhage ,early thrombosis, steal or heart failure this can be explained by full investigation done to all cases ,5000iu heparin given to all patients intra operative , proper size of arteriotomy &venotomy. Analysis revealed that the causative factor of failed cases were severe attack of severe hypotension and diabetes.
Conclusion:
Diabetes and severe attack of hypotension, kink or twist of Basilic vein during its transposition intraoperative explain occurrence of complication (thrombosis) in A V F. transposition of forearm basilic vein in arteriovenous fistula was successfully completed in 26 (86.7%), whereas the rate of failure was found in 4 cases (13.3%). Forearm BVT showed an acceptable, high patency rate and fewer thromboses and infectious complications than AVG. Forearm BVT could be considered before forming an upper arm AVF or forearm AVG, if the basilic vein is available.
Recommendation:
The use of forearm basilic vein to create a native AVF appears to be good alternative procedures in the antecubital fossa or the upper arm. Thus preserving more proximal veins for future use. The operation is technically more challenging and time consuming than creation of typical brachiocephalic access, but should be performed much more frequently.
Radiobasilic AVF is recommended to be the second choice after radiocephalic AVF.Radiobasilic AVF might be the first choice if the cephalic veins in both forearms are not suitable for access.