Radio-Cephalic Fistula for Hemodialysis
Fistulas for hemodialysis are generally created in the limbs – either in the arms or legs, with the arms being the most common location and preferably using the lower half of the arm (where the muscles are less prominent). Non dominant hand should be used when possible.
The best type of fistula should use native veins and arteries, as they tend to last longer and have significantly less complications. Listed here the most common fistula technique, the radio-cephalic fistula. Other variations are possible, and are used when there have been multiple vascular access surgeries previously.
Radio-cephalic wrist fistulas (also known as Brescia-Cimino fistula) was first devised in 1966, and it is the most common fistula type used but also the most difficult. A radio-cephalic fistula in the non-dominant arm should be first choice when AV fistula access is needed, with a reported patency 2 years post placement of 90%.
A cephalic vein proximal to the wrist is chosen and undergoes testing to ensure normal blood circulation.
The arm is then prepped for surgery.
Generally, a vertical incision is made between the radial artery and the cephalic vein. Some surgeons prefer making the incision more distally and using the deep branch of the radial artery in order to create the fistula.
The cephalic vein and radial artery are superficially located and are easily exposed. They are then placed adjacent to each other, side by side, and brought together by use of vessel loops.
An incision is made in the cephalic vein and a small incision is made in the radial artery (the arteriotomy is limited to 6-7 mm length, in order to reduce likelihood of steal syndrome occurring), and a side-to-side anastomosis is created by suturing the vein and artery together. A probe is passed up the cephalic vein and radial artery through an opening in the distal cephalic artery, and the fistula is perfused to ensure adequate blood flow. Other variations are end-to-side or end-to-end anastomoses, done by dividing the cephalic vein and connecting it to the artery.
The Radio-cephalic fistula generally requires a period of 2-3 months of maturation before it can be used for hemodialysis access.
When Radio-cephalic wrist fistula is not an option due to weak veins or previous failure, an attempt is made at creating a more proximal fistula.
Fistula maturation and patency rates can be improved by using VasQ™, Laminate Medical Technologies’ revolutionary device (currently only of brachiocephalic fistulas). Read more about VasQ™ for hemodialysis patients.