Korean J Thorac Cardiovasc Surg.  2020 Feb;53(1):28-33. 10.5090/kjtcs.2020.53.1.28.

Videoscopic Surgery for Arteriovenous Hemodialysis Access

• Jeong H
• Bae M
• Chung SW
• Lee CW
• Huh U
• Kim MS

• KMID: 2502529
• DOI: http://doi.org/10.5090/kjtcs.2020.53.1.28

Abstract

Background
When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions.
Methods
Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed.
Results
Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days).
Conclusion
Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.

Keyword

Arteriovenous fistula; Endoscopy; Basilic vein