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    • The Outcome of Simultaneous Brachial Artery Reconstruction and New Arteriovenous Fistula Construction using Great Saphenous Vein Conduit in Abandoned Limbs Due to Previously Ligated Brachial Artery

    Usama Lotfi (MD, MRCS) , Hisham Mostafa (MD), Maher Abdelmonem (MD), Ahmed Reyad (MD)
    Department of Vascular Surgery, Faculty of Medicine, Cairo University

    Background: Well functioning vascular access is considered the cornerstone for efficient regular hemodialysis and good overall quality of life. The ever-increasing life expectancy of patients on hemodialysis is accompanied with increasing subsets of those with exhausted upper extremity accesses. Aim of the study: To evaluate the feasibility, safety, limitations and outcome of using a great saphenous vein graft (GSV) to reconstruct a previously ligated brachial artery, and simultaneously construct a new autogenous arteriovenous fistula (AVF). Patients and methods: This study included 18 end stage renal disease patients on regular hemodialysis who had previous brachial artery ligation due to complicated AVFs or AV grafts (AVG); and already had exhausted other safe access sites. A GSV graft was used as a conduit to reconstruct the brachial artery and construct a new AVF. Technical success, operative time, complication and patency rate were evaluated. Results: Although some difficulties where encountered in 3 patients, yet, technical success were the end result in all patients with their fistulae got matured. The operative time was 70-120 minutes (mean 90 minutes). The mean follow up was 24 months. Neither early nor late thrombosis was encountered in brachial artery reconstruction, whereas, two cases of thrombosis were met in fistula construction after 3 and 11 months. One case developed grade I vascular steal. Late access stenosis occurred in 5 cases. At 6, 12, 18, 24 months, the primary patency rates of the constructed fistulae were 83.3%, 77.7%, 72.2%, 61.1% while the secondary patency rates were 88.8%, 83.3%, 77.7%, 66.6%. Conclusion: Simultaneous brachial artery reconstruction and new fistula construction using great saphenous vein conduit in limbs with previously ligated brachial artery proved to be feasible and safe with reasonable outcome. It offers a valid autologous alternative in some patients with limited vascular access options as a bail-out procedure before embarking to more sophisticated options. Key words: Brachial artery ligation, ruptured arteriovenous fistula, saphenous vein graft.

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