Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Videoscopic Surgery for Arteriovenous Hemodialysis Access

  • Jeong, Hyuncheol (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital) ;
  • Bae, Miju (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital) ;
  • Chung, Sung Woon (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital) ;
  • Lee, Chung Won (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital) ;
  • Huh, Up (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital) ;
  • Kim, Min Su (Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital)
  • Received : 2019.04.18
  • Accepted : 2019.07.29
  • Published : 2020.02.05
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Abstract

Background: When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. Methods: Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. Results: Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). Conclusion: Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.

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