The Experts below are selected from a list of 4407 Experts worldwide ranked by ideXlab platform
William C. Jennings - One of the best experts on this subject based on the ideXlab platform.
-
Extending outflow Brachial Vein tength for transposition arteriovenous fistulas
The journal of vascular access, 2011Co-Authors: William C. Jennings, C. Anthony Howard, Fred S. Lee, Dirk McmurrayAbstract:PURPOSE Transposition arteriovenous fistulas (T-AVF) play an important role in establishing autogenous vascular access for many hemodialysis patients. When the basilic Vein is not available, one of the paired Brachial Veins offers a reliable T-AVF option, generally as a two-staged operation. Uncommonly, the Brachial Vein outflow conduit dissipates into multiple small branches communicating with the paired Brachial Vein or occasionally with a residual proximal segment of the basilic Vein. We utilized parallel outflow Vein component segments to create additional outflow Vein length necessary for successful T-AVFs in these patients. MATERIALS AND METHODS We identified four patients where a Vein length extension technique utilizing parallel and overlapping Vein segments with an end-to-end anastomosis gained adequate length for successful T-AVFs. All transpositions were based on a first stage AVF with access outflow established into a Brachial Vein. CASE REPORTS Three of the operations utilized paired Brachial Vein segments and one gained needed access outflow length with a Brachial Vein anastomosis to a residual proximal basilic Vein segment. All four patients had functional T-AVFs at 4, 5, 7, and 14 month follow-up. None of the patients developed arm swelling. CONCLUSIONS Creating a longer transposition AVF venous outflow segment using parallel and overlapping Vein segments with an end-to-end anastomosis gained the adequate length needed for successful T-AVFs in these four patients.
-
Brachial Vein transposition arteriovenous fistulas for hemodialysis access
Journal of vascular surgery, 2009Co-Authors: William C. Jennings, Matthew J. Sideman, Kevin E. Taubman, Thomas A. BroughanAbstract:Background An arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, offering lower morbidity, mortality, and cost compared with grafts or catheters. Patients with a difficult access extremity have often lost all superficial Veins, and even basilic Veins may be obliterated. We have used Brachial Vein transposition AVFs (BVT-AVFs) in these challenging patients and review our experience in this report. Methods The study reviewed consecutive patients in whom BVT-AVFs were created from September 2006 to March 2009. Most BVT-AVFs were created in staged procedures, with the second-stage transposition operations completed 4 to 6 weeks after the first-stage AVF operation. A single-stage BVT-AVF was created when the Brachial Vein diameter was ≥6 mm. Results We identified 58 BVT-AVF procedures, comprising 41 women (71.0%), 28 diabetic patients (48.3%), and 29 (50.0%) had previous access surgery. The operation was completed in two stages in 45 operations (77.6%) and was a primary transposition in 13 patients. However, five of these were secondary AVFs with previous distal AV grafts or AVFs placed elsewhere; effectively, late staged procedures. Follow-up was a mean of 11 months (range, 2.0-31.7 months). Primary patency, primary-assisted patency, and cumulative (secondary) patency were 52.0%, 84.9%, and 92.4% at 12 months and 46.2%, 75.5%, and 92.4% at 24 months, respectively. Harvesting the Brachial Vein was tedious and more difficult than harvesting other superficial Veins. No prosthetic grafts were used. Conclusion BVT-AVFs provide a suitable option for autogenous access when the basilic Vein is absent in patients with difficult access extremities. Most patients required intervention for access maturation or maintenance. Most BVT-AVFs were created with staged procedures. Cumulative (secondary) patency was 92.4% at 24 months.
-
Primary and staged transposition arteriovenous fistulas
Journal of vascular surgery, 2008Co-Authors: Michael R. Arroyo, Matthew J. Sideman, Lawrence M. Spergel, William C. JenningsAbstract:Background The use of catheters or prosthetic grafts for vascular access has significantly higher mortality and morbidity risks, in addition to higher costs, than arteriovenous fistulas (AVF). Many patients have a difficult access extremity due to complex medical illnesses, previous vascular access procedures, intravenous catheters, diabetes, vascular disease, female sex, age, and other complicating factors. Transposition AVFs (AVF-T) have been used for these individuals to avoid catheters and grafts. We report our experience with primary and staged basilic Vein AVF-Ts and staged Brachial Vein AVF-Ts. Methods From our database of consecutive vascular access operations, we reviewed patients from May 2003 to September 2006 for all upper extremity AVF-Ts. A primary AVF-T was used when the basilic Vein was continuous with a minimum diameter of 4 mm and of adequate length. When the basilic Vein was 2.5 to 4 mm, the procedure was staged. The proximal radial artery was used for inflow, if possible. When the basilic Vein was not suitable, a radial Vein or Brachial Vein anastomosis was performed as the first stage of a planned Brachial Vein AVF-T. The second stage operations of staged AVF-Ts were generally done 4 to 6 weeks after the primary AVF construction. All patients were evaluated with preoperative ultrasound imaging by the operating surgeon. Results From a database of 412 consecutive vascular access patients, 78 upper extremity transposition procedures were identified. Of these, 57 patients (73.1%) were women, 44 (56.4%) were diabetic, and 46 (59.0%) had previous access surgery. Fifty-eight operations were staged procedures. The basilic Vein was used in 68 AVF-T, the Brachial Vein in six, and cephalic Vein in four. The anastomosis was based on the proximal radial artery in 60 patients. Mean follow-up was 18 months (range, 3-48 months). Primary patency, primary assisted patency, and cumulative patency were 45.7%, 93.5%, and 96.0% at 12 months and 27.6%, 86.5%, and 88.9% at 24 months, respectively. No prosthetic grafts were used in the study period. Conclusion Both primary and staged AVF-T procedures were successfully used in patients with difficult access extremities. AVF-Ts were durable, although many required an interventional procedure for maturation or maintenance. Cumulative (secondary) patency was 96.0% at 12 months and 88.9% at 24 months. The absence of an adequate basilic Vein does not preclude the use of a staged AVF-T because the Brachial Vein offers a suitable alternative.
Harry Schanzer - One of the best experts on this subject based on the ideXlab platform.
-
Brachial Vein transposition arteriovenous fistula: is it an acceptable option for chronic dialysis vascular access?
The journal of vascular access, 2008Co-Authors: P.j. Torina, E.f. Westheimer, Harry SchanzerAbstract:PURPOSE The aim of this study was to evaluate the midterm performance of Brachial Vein arteriovenous fistulas (AVFs) and to compare this performance with arteriovenous grafts (AVGs) and basilic Vein transposition AVFs. METHODS A retrospective analysis was performed. Between December 2002 and October 2006, 149 AV access procedures consisting of Brachial Vein transposition AVFs (11 one-stage and 2 two-stage procedures), basilic Vein transposition AVFs (n=42), and AVGs (n=94) were performed in 141 patients. RESULTS 73% of one-stage Brachial Vein AVF patients experienced at least one complication during follow-up vs. 52% of the basilic Vein transposition AVF group and 55% of the AVG group. The primary patency rates at 12 months for one-stage Brachial Vein AVFs, basilic Vein AVFs, and AVGs were 24, 45 and 50%, respectively. The assisted primary patency rates were 45, 74 and 63%, and the secondary patency rates were 45, 74 and 78%, respectively. A significant difference in the overall secondary patency rates between one-stage Brachial Vein AVF and AVGs (p=0.015) was detected. Significance was approached between one-stage Brachial Vein AVFs and basilic Vein AVFs overall assisted primary patency (p=0.055) and secondary patency (p=0.055) rates. CONCLUSION The Brachial Vein transposition, when done as a one-stage procedure, is associated with inferior patency rates when compared to the basilic Vein transposition AVF and AVG. Therefore, in the setting of inadequate cephalic and basilic Vein, a prosthetic graft is superior to a Brachial Vein transposition. A two-stage procedure, as suggested by others, may improve the results of this technique.
-
Transposition of the Brachial Vein: a new source for autologous arteriovenous fistulas
Journal of vascular surgery, 2004Co-Authors: Hernan A. Bazan, Harry SchanzerAbstract:Increasing the prevalence of arteriovenous fistula over arteriovenous synthetic graft is critical for decreasing the morbidity and costs of dialysis patients. This is highlighted in the guidelines set forth by The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI), which encourage the increased use of autogenous Vein in fistula creation. In addition to the basilic and cephalic Veins, another source of autogenous Vein is the Brachial Vein, a deep Vein of the upper arm. Here we describe 2 patients with absence of adequate superficial Veins, in whom a transposed Brachial Vein was used for the creation of an arteriovenous fistula.
Heejun Yang - One of the best experts on this subject based on the ideXlab platform.
-
The distal and proximal connections of the lateral venous channel with the Veins in the upper limb.
2019Co-Authors: Hyeyeon Lee, Jongho Bang, Soojung Kim, Heejun YangAbstract:The channel was distally connected to the basilic Vein, common Brachial Vein, medial Brachial Vein, deep Brachial Vein and anterior circumflex humeral Vein. The Vein which was joined by the channel was the axillary Vein or the cephalic Vein. The most frequently observed connection was the connection between the lateral Brachial Vein and the axillary Vein, which was observed in 45.2% of the upper limbs with the Vein.
-
The frequencies / rates of the drainage of Veins into the cephalic Vein in the upper limbs.
2019Co-Authors: Hyeyeon Lee, Jongho Bang, Soojung Kim, Heejun YangAbstract:The tributaries are the thoracoacromial Vein, acromial Vein, pectoral Vein, clavicular Vein, deltoid Vein, lateral venous channel, superior thoracic Vein and deep Brachial Vein.
-
Lateral venous channel in a right axilla.
2019Co-Authors: Hyeyeon Lee, Jongho Bang, Soojung Kim, Heejun YangAbstract:A lateral venous channel is connecting the lateral Brachial Vein and the retropectoral part of the axillary Vein. The anterior circumflex humeral Veins are entering the lateral venous channel.
-
Novel findings of the anatomy and variations of the axillary Vein and its tributaries.
Clinical anatomy (New York N.Y.), 2012Co-Authors: Heejun Yang, Young-chun Gil, Jeong-doo Jin, Hyejin Cho, Hyun Kim, Hyeyeon LeeAbstract:The anatomy and variations of the axillary Vein has significant implications in various invasive procedures such as venous access, axillary block, arteriovenous fistula creation, axillary node dissection, breast augmentation, and other surgical procedures involving the axilla. To clarify the anatomy of the axillary Vein and its tributaries, 40 cadaveric upper extremities were examined after dissection and were classified into several types according to the courses and terminations of Brachial Veins. The Brachial Veins ended separately (Type A; 72.5%) or made a common Brachial Vein (Type B; 27.5%) to enter the basilic Vein or the axillary Vein. The basilic Vein was absent in 5.0% of the specimens. Duplication of the axillary Vein was observed in 17.5% of the specimens and the lateral venous channel running along the lateral wall of the axilla was observed in 40.0% of the specimens. The most common drainage Vein of the deep Brachial Vein was the lateral Brachial Vein (67.5%). The anterior circumflex humeral Vein also emptied into the lateral Brachial Vein in 67.5% of the specimens. The posterior circumflex humeral Vein crossed posterior side of the Brachial plexus to join either the axillary Vein (45.0%) or subscapular Vein (42.5%). Perforation of the lateral root of median nerve by a lateral Brachial Vein, a common Brachial Vein, or a venous channel was observed in 15.0% of the specimens. Other venous variations accompanying the variations of the axillary artery or the Brachial artery are described herein. The clinical importance of these findings is described in the discussion. Clin. Anat. 25:893–902, 2012. © 2012 Wiley Periodicals, Inc.
M. Derya Balbay - One of the best experts on this subject based on the ideXlab platform.
-
Comparison of antioxidant enzyme activity in the internal spermatic Vein and Brachial Veins of patients with infertile varicocele.
International Urology and Nephrology, 2008Co-Authors: Emin Ozbek, Mustafa Cekmen, Abdulmuttalip Simsek, Yusuf Turkoz, Ahmet Soylu, Y. Ozlem Ilbey, M. Derya BalbayAbstract:Aim Recent studies have shown that both oxidative and reductive stresses are present within the internal spermatic Vein of patients with varicocele. The aim of this study was to compare the activities of antioxidant enzymes in the internal spermatic Vein and Brachial Vein of patients with varicocele.
-
The role of adrenomedullin in varicocele and impotence.
BJU international, 2001Co-Authors: Emin Ozbek, Ahmet Soylu, M. Yurekli, M. Davarci, M. Derya BalbayAbstract:Objective To assess the levels of adrenomedullin (a vasodilatory peptide) in penile blood before and after injection with papaverine in impotent men, and in the internal spermatic Vein in infertile patients with varicocele, comparing the results with levels in the Brachial Vein in the same patients. Patients and methods Intracavernosal levels of adrenomedullin were determined in 14 impotent men (with no vascular pathology, as assessed by colour Doppler ultrasonography) before and after papaverine-induced penile erection. The effect of needle puncture alone was assessed in eight control patients. The level of adrenomedullin was also measured in the internal spermatic Vein and Brachial Vein in 14 infertile men with varicocele. Results The mean ( sd) intracavernosal adrenomedullin levels in the 14 impotent men were significantly different between the flaccid and papaverine-induced erectile state, at 93.5 (33.0) and 135.8 (34.9) pmol/mL, respectively, (P
Tomasz Zubilewicz - One of the best experts on this subject based on the ideXlab platform.
-
Axial splitting of the medial anteBrachial cutaneous nerve facilitates second-stage elevation of basilic or Brachial Vein in patients with arteriovenous fistula.
Journal of vascular surgery, 2015Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz ZubilewiczAbstract:We describe a novel surgical technique to facilitate the second-stage elevation of the basilic or Brachial Vein in patients with first-stage Brachial-basilic or autogenous Brachial-Brachial arteriovenous fistula by axial splitting of the medial anteBrachial cutaneous nerve (MABCN). Filaments of the MABCN typically traverse the anterior aspect of the basilic and Brachial Veins. The second-stage elevation/shelf superficialization of the basilic or Brachial Vein, so as not to cause an injury to the MABCN, requires division of these Veins with transposition over the nerve branches and subsequent reanastomosis. Our method of axial splitting of the MABCN enables elevation and shelf superficialization of the basilic or Brachial Vein without the division and reanastomosis of the Vein. Twenty-eight patients underwent this simplified elevation. The nerve perineurium was incised longitudinally, nerve fibers were divided intrafascicularly, and cutaneous nerve branches were retracted aside. The Vein was elevated between the divided nerves. On discharge and at 1-month follow-up, only one patient complained of localized patch hypoesthesia as reported in a simplified neurologic assessment questionnaire and neurologic examination.
-
Superficialization of segmentally matured Brachial Vein complex as the last possible native, upper arm vascular access for hemodialysis.
The journal of vascular access, 2015Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz ZubilewiczAbstract:PURPOSE We present a case report on superficialization of the segmentally matured Brachial Vein complex as the last possible native vascular access for hemodialysis in the upper arm. METHODS A 57-year-old, female patient was hemodialysed for 14 years. Due to multiple failures of her previous forearm and upper arm vascular access for hemodialysis, the last attempt at the creation of upper arm native vascular access was planned in terms of the formation of a two-stage autogenous Brachial-Brachial arterio-venous fistula (ABBA). The second stage exposure of the Brachial Vein - 4 weeks after anastomosis with the Brachial artery showed an unusual intraoperative situation. Segmental maturation of both Brachial Veins, connected by a bridging Vein was encountered. Both the mature segments of the Brachial Veins, connected by the bridging Vein were elevated/superficialized into a subcutaneous bed. Immature parts of Brachial Veins were left near their anatomical position. RESULTS Superficialized venous conduit was easily accessible and provided adequate parameters of uncomplicated hemodialysis for 6 months. In month 7, thrombosis of the fistula caused by an embolus due to an atrial fibrillation episode required thrombo-embolectomy. The fistula is still in use 13 months after its creation. CONCLUSIONS Our technique is feasible in cases of unusual, segmental maturation of both Brachial Veins during two-stage ABBA formation. Selective superficialization of matured segments only may provide suitable access for hemodialysis. Vascular access surgeons should be aware of possible anatomical variations and be prepared to perform unusual access configurations as dictated by the local anatomy.
-
Two-stage anterotransposition of the Brachial Vein as the new option for native vascular access for hemodialysis : A report of 3 cases
Dialysis & Transplantation, 2006Co-Authors: Stanisław Przywara, Piotr Terlecki, Tomasz Zubilewicz, Jacek Wroński, Marcin Feldo, Anna Skublewska‐bednarekAbstract:Background We present 3 cases of 2-stage anterotransposition of the Brachial Vein to be considered the last option for native vascular access for hemodialysis before forearm/upper arm graft placement. Methods Three patients with chronic renal insufficiency were admitted for the creation of vascular access for hemodialysis. Physical examination, confirmed by ultrasonography, revealed the absence of adequate cephalic and basilic Veins. In each case, precise color Doppler ultrasound examination showed a Brachial artery with the appropriate diameter and 2 wide Brachial Veins joining into 1 axillary Vein in the axillary fossa. Surgery was performed in 2 stages. In the first stage, one of the Brachial Veins was anastomosed with the Brachial artery end to side in the cubital fossa. The fistula was left for 4 weeks to mature, with the Brachial Vein in its anatomical location. During the second stage, the entire length of the Brachial Vein was exposed via 1 longitudinal incision from cubital fossa up to armpit. Mobilized Vein was subcutaneously transposed to an anterior location. Results At present, 8–20 months after the procedure, venous pressures are within accepted ranges and hemodialysis is adequate. Conclusions Our technical report confirms that the Brachial Vein can be utilized as the last option for the creation of native vascular access on the upper arm. We recommend that the surgery be performed in 2 stages. Maturation of the Vein in its anatomical location, which occurs between the first and second stages of surgery, assures proper dilatation and thickening of the Vein, making it better able to resist the extensive dissection and transposition during the second stage.