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Nam Cheol Park - One of the best experts on this subject based on the ideXlab platform.

  • 2188 reactive oxygen species in the internal spermatic and Brachial Veins of patients with varicocele induced infertility
    The Journal of Urology, 2011
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    Purpose: The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Materials and Methods: Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. Results: The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Conclusions: Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

  • Reactive Oxygen Species in the Internal Spermatic and Brachial Veins of Patients with Varicocele-Induced Infertility
    Korean journal of urology, 2010
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

  • reactive oxygen species in the internal spermatic and Brachial Veins of patients with varicocele induced infertility
    Korean Journal of Urology, 2010
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    PURPOSE: The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. MATERIALS AND METHODS: Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. RESULTS: The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. CONCLUSIONS: Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

Chang Jin Yoon - One of the best experts on this subject based on the ideXlab platform.

  • 2188 reactive oxygen species in the internal spermatic and Brachial Veins of patients with varicocele induced infertility
    The Journal of Urology, 2011
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    Purpose: The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Materials and Methods: Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. Results: The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Conclusions: Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

  • Reactive Oxygen Species in the Internal Spermatic and Brachial Veins of Patients with Varicocele-Induced Infertility
    Korean journal of urology, 2010
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

  • reactive oxygen species in the internal spermatic and Brachial Veins of patients with varicocele induced infertility
    Korean Journal of Urology, 2010
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    PURPOSE: The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. MATERIALS AND METHODS: Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. RESULTS: The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. CONCLUSIONS: Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

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, 2015
    Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz Zubilewicz
    Abstract:

    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, 2015
    Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz Zubilewicz
    Abstract:

    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.

  • Superficialization of segmentally matured Brachial vein complex as the last possible native, upper arm vascular access for hemodialysis.
    The journal of vascular access, 2015
    Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz Zubilewicz
    Abstract:

    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. 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. 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. 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, 2006
    Co-Authors: Stanisław Przywara, Piotr Terlecki, Tomasz Zubilewicz, Jacek Wroński, Marcin Feldo, Anna Skublewska‐bednarek
    Abstract:

    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.

Hyun Jun Park - One of the best experts on this subject based on the ideXlab platform.

  • 2188 reactive oxygen species in the internal spermatic and Brachial Veins of patients with varicocele induced infertility
    The Journal of Urology, 2011
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    Purpose: The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Materials and Methods: Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. Results: The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Conclusions: Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

  • Reactive Oxygen Species in the Internal Spermatic and Brachial Veins of Patients with Varicocele-Induced Infertility
    Korean journal of urology, 2010
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

  • reactive oxygen species in the internal spermatic and Brachial Veins of patients with varicocele induced infertility
    Korean Journal of Urology, 2010
    Co-Authors: Chang Jin Yoon, Hyun Jun Park, Nam Cheol Park
    Abstract:

    PURPOSE: The aim of this study was to evaluate the relationship between the levels of reactive oxygen species (ROS) and the clinical characteristics of varicoceles among patients with varicocele-induced infertility. MATERIALS AND METHODS: Ninety-eight patients with infertile varicocele and 22 control subjects without varicocele were enrolled. Blood samples were drawn from the Brachial vein (BV) and the dilated internal spermatic vein (ISV) on the side of the varicocele during surgery. ROS levels were determined by spectrophotometry, and comparisons between the varicocele and control groups were performed. In addition, the ROS levels were analyzed according to the characteristics of the varicocele, and ROS levels in the ISV and the BV were compared. RESULTS: The ROS levels measured in the ISV of men with varicocele were higher than in the control group regardless of the varicocele grade except for subclinical grade; however, in the BV, a difference was noted only for grade III. When the difference in testis volume between sides was greater than 3 ml, and the varicocele had been present for more than 3 years, ROS levels were higher in the ISV than in the BV. Sperm viability was significantly associated with ROS levels. Serum hormone levels were not correlated with ROS levels. CONCLUSIONS: Serum ROS levels were higher in infertile men with a varicocele than in controls. They were correlated with varicocele grade, varicocele duration, the degree of testicular hypotrophy, and sperm viability. In addition, ROS levels and their associations with clinical characteristics were higher in the ISV than in the BV.

Stanisław Przywara - 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, 2015
    Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz Zubilewicz
    Abstract:

    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, 2015
    Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz Zubilewicz
    Abstract:

    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.

  • Superficialization of segmentally matured Brachial vein complex as the last possible native, upper arm vascular access for hemodialysis.
    The journal of vascular access, 2015
    Co-Authors: Stanisław Przywara, Marek Iłżecki, Piotr Terlecki, Tomasz Zubilewicz
    Abstract:

    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. 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. 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. 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, 2006
    Co-Authors: Stanisław Przywara, Piotr Terlecki, Tomasz Zubilewicz, Jacek Wroński, Marcin Feldo, Anna Skublewska‐bednarek
    Abstract:

    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.