A TECHNICAL MODIFICATION CHANGING THE LOCAL HEMODYNAMIC CHARACTERISTIC OF THE END-TO-SIDE ARTERIOVENOUS FISTULA IN THE DISTAL FOREARM

Abstract

Diminishing the turbulence at radio-cephalic end-side arteriovenous (AV) fistulas performed at wrist level, as well as preventing thrombotic occlusion by increasing the rate of flow was intended. The study was performed in a prospective manner in our clinic between 01.01.2000 and 15.12.2002. A technical modification which aimed to decrease the turbulence at the A-V fistula area performed end-side and increase the rate of flow at the fistulized vein was tested in the study, and local hemodynamic properties of this technical modification were evaluated by Colour-Doppler monitoring device. In 50 patients who were having end-stage renal failure, radial artery and cephalic vein was routinely prepared by 2 cm skin incision performed longituidinally at the ventral side of the wrist and anastomosed. Both vascular structures were anastomosed in a way that they would make an obtuse angle (>90°) at the proximal edge of anastomosis. In no case, occlusion, infection, aneurysm or fistula-induced heart failure was observed. Doppler results revealed the observations that there were nor preoperative neither postoperative diameter changes, run of fistula increased in acceptable limits (400-700 cc/min), rate of flow increased 5 times and the flow became more closer to laminar flow which is more physiological than turbulent flow, 30 % of the blood coming from proximal artery passed to distal artery and 70 % of the blood coming from proximal artery was canalized to fistulized vein. It is concluded that an increase in the rate of flow prevents the occlusion, and by means of this technical modification, an effective arteriovenous fistula can be formed even in small vessels.