Novel classification of proximal forearm perforator vein in the planning and creation of percutaneous and surgical Gracz-type arteriovenous fistulae

Shahverdyan, Robert ORCID: 0000-0002-8352-0954, Konner, Klaus, Segerer, Stephan and Wasse, Haimanot . Novel classification of proximal forearm perforator vein in the planning and creation of percutaneous and surgical Gracz-type arteriovenous fistulae. J. Vasc. Access. LONDON: SAGE PUBLICATIONS LTD. ISSN 1724-6032

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DOI:10.1177/11297298221141480

Abstract

Background: The perforator vein determines whether it is feasible to create a percutaneous (pAVF) or surgical Gracz-type arteriovenous fistula (sAVF). Creating a standard anatomic classification of the antecubital region is beneficial to both the selection of the appropriate device and/or procedure and technical outcomes. Accordingly, an analysis of a large cohort of patients undergoing pAVF/sAVF was performed, focusing on perforator vein anatomical suitability, and a novel anatomical classification of the antecubital region was developed and proposed. Methods: Between August 2018 and July 2022, chronic or end-stage kidney disease patients as well as patients anticipated an initiation of apheresis, who were referred for vascular access planning, underwent a standardized evaluation of upper extremities. A vessel mapping summary detailing the vasculature and the access creation plan was completed, indicating the anatomical suitability for sAVF and pAVF (Ellipsys and WavelinQ) techniques. Results: Of 524 patients, 36.5% were female (average age 65 years). 53.2% were on dialysis, 41.6% had diabetes, and 13.2% had a previously failed permanent dialysis access. The anatomy for successful pAVF creation was judged to be suitable in 54% of patients for an Ellipsys-pAVF, and 29.8% for WavelinQ-pAVF. Of the WavelinQ group, 54.4% had suitable anatomy for ulnar, 26.9% for radial, and 18.6% for both ulnar/radial anastomoses. Additionally, 60.7% had suitable anatomy for pAVF creation with at least one of the systems, while 22.5% were suited for both types of pAVF-systems. 80.3% were candidates for creation of a Gracz-AVF. Conclusion: Overall, we found that about 60% of patients are likely candidates for a pAVF, with 80% being candidates for creation of a Gracz-AVF. Male patients have significantly higher suitability for most types of AVF creation, and younger patients are more suitable for Ellipsys-pAVF and RCAVFs. Most importantly, a universal classification of perforator vein was developed, which is indispensable in modern vascular access planning.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Shahverdyan, Robert	UNSPECIFIED	orcid.org/0000-0002-8352-0954	UNSPECIFIED
Konner, Klaus	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Segerer, Stephan	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Wasse, Haimanot	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED