TITLE: Multicentre Study on the Efficacy of Brachial Artery Transposition Among Haemodialysis Patients.

OBJECTIVE: Brachial artery transposition (BAT) is not a well known method for obtaining vascular access (VA) for maintenance haemodialysis. This study evaluated the outcomes of BAT.

METHODS: This multicentre retrospective cohort study included 233 consecutive patients who underwent BAT between January 2012 and December 2013. The indications were inadequate vessels for obtaining VA, severe heart failure, hand ischaemia, central vein stenosis/occlusion, or a history of catheter/graft infection. The transposed brachial artery was used only for arterial inflow and other routes were used for outflow.

RESULTS: BAT was successful in 227 patients, and adequate blood flow was achieved during dialysis sessions. The first successful cannulation was after a median of 18 days. BAT was performed using superficial veins as the return route in 127 patients and arteriovenous fistula (AVF) creation in 63 patients to prevent maturation failure. In 41 patients with central venous catheterisation, the transposed brachial artery was used for arterial inflow. The complications of BAT were impaired wound healing in 14 patients, including skin necrosis in two; large aneurysms in six, including a mycotic pseudo-aneurysm in one; arterial thrombosis in five; hand ischaemia in five; lymphorrhoea in four; and haematoma/bleeding in three. The transposed brachial artery was abandoned in four, three, three, and one case of arterial thrombosis/stenosis, haematoma/bleeding, skin necrosis, and large aneurysm, respectively. Access to the return routes failed in 48 cases because of vein damage caused by cannulation in 22, AVF thrombosis/stenosis in 14, catheter infection in six, and catheter occlusion in six. At two years, the primary patency rates of the transposed brachial artery and access circuit were 88% and 54%, respectively.

CONCLUSION: BAT is a safe and effective technique. The patency was high for the transposed brachial artery but adequate for the access circuit. BAT can be considered for patients with an unobtainable standard arteriovenous access.

SOURCE: Murakami M, Mori K, Hamanoue S, et al. Multicentre Study on the Efficacy of Brachial Artery Transposition Among Haemodialysis Patients[J]. Eur J Vasc Endovasc Surg, 2021,DOI: 10.1016/j.ejvs.2021.01.038.

目的：肱动脉浅置术（BAT）不是获得维持性血液透析血管通路（VA）的常规方法。这项研究评估了BAT的效果。

方法：这项多中心回顾性队列研究包括2012年1月至2013年12月之间连续接受BAT的233例患者。适应症包括获取血管不足的血管、严重心力衰竭、手部缺血、中心静脉狭窄/闭塞或有导管/移植物感染的病史。移位的肱动脉仅用于动脉流入，其他途径用于流出。

结果：BAT成功应用于227例患者，并且在透析过程中获得了足够的血流量。首次成功穿刺时间为18天后（中位数）。 其中127例患者使用浅静脉作为回血路径，63例患者建立动静脉内瘘（AVF）以防止成熟失败。在41例中心静脉导管置入的患者中，经转位的肱动脉用于动脉流入。 BAT的并发症包括：14例患者伤口愈合困难，其中2例皮肤坏死，3例患者皮肤坏死，6例大动脉瘤，其中包括1个霉菌性假性动脉瘤；5例动脉血栓形成；5例手部缺血，4例淋巴结肿大，3例血肿/出血。分别在4例动脉血栓形成/狭窄，3例血肿/出血，3例皮肤坏死和1例大动脉瘤中抛弃了移位的肱动脉。在48例患者中，由于22例因穿刺引起的静脉损伤，14例因AVF血栓形成/狭窄，6例导管感染和6例导管阻塞，因此无法使用回血路径。两年后，转位肱动脉和通路的通畅率分别为88％和54％。

结论：BAT是一种安全有效的技术。肱动脉浅置的通畅率很高，足以进入通路。对于无法获得标准动静脉通路的患者，可以考虑采用BAT。

启发：在一些特殊情况，只要能提供有效的出量，通畅的回路，就可以建立有效的透析通路。