Dorobantu LF et al. (2006) The brachio-brachial arteriovenous fistula: a new method in patients without a superficial venous system in the upper limb. J Vasc Access 7: 87–89

Some patients who require hemodialysis present with a superficial venous system of the upper limb that is inadequate for the creation of an arteriovenous fistula. Prosthetic grafts are recommended in these cases, but have been associated with high rates of thrombosis and infection. Dorobantu et al. have evaluated an alternative procedure that creates a fistula from the brachial artery and a brachial vein.

This retrospective analysis included 33 patients in whom a brachiobrachial fistula had been created in an end-to-side configuration. One month after surgery, 27 (81.8%) of these patients had a functional fistula, which was suitable for hemodialysis following transposition to subcutaneous tissue. During the 1-month maturation period, the fistula became occluded in six patients. Twelve patients developed temporary edema of the forearm during the first month following surgery, but the authors reported no other complications associated with the procedure. Follow-up lasted 3–26 months (mean 14 ± 6.6 months), during which a further 4 of the 27 patients presented with fistula occlusion.

Fistulas formed from native vessels are the preferred option, and the authors propose the brachiobrachial approach as a viable alternative to prosthetic grafts, noting that a suitable brachial vein is always available. They suggest that a study of a larger patient sample with longer follow-up would confirm the patency and safety of brachio–brachial fistulas, relative to prostheses.