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Dialysis access
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
P.C. Balraj, Arielle Hodari-Gupta, G. Haddad
Exposure for a radio-cephalic fistula begins with a longitudinal incision at the wrist that is deepened through the subcutaneous tissue. The cephalic vein is identified and isolated from the surrounding structures. The fascia is entered and the radial artery is isolated with the radial veins in a bundle and surrounded with a vessel loop. The vein and artery are inspected to ensure that they are of adequate size to proceed. After the patient is anticoagulated with heparin, the cephalic vein is divided and the distal end is ligated. With vascular control of the radial artery, a longitudinal arteriotomy is created. The cephalic vein end is slightly beveled and brought over to the artery. An end of cephalic vein-to-side of radial artery anastomosis is then performed with fine running (7-0) polypropylene suture. Before completing the anastomosis, the vein and the artery are allowed to bleed; the anastomosis is then completed. Next, it is important to assess the fistula by palpating a thrill at the anastomosis. The incision is closed with 3-0 absorbable suture for the subcutaneous tissue and staples for the skin.
Single versus dual venous anastomosis in radial forearm free flaps in head and neck reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2023
This study concentrates on the recipient vein. We believe that double vein anastomoses can reduce vein compromise in the application of RFFFs. First, the relationship between the EJV and IJV systems resembles the relationship between the cephalic and radial veins. The diameter of the cephalic vein varies along the vein, with the largest diameter being ∼3.5 mm at the cubital fossa. The radial vein has a smaller caliber and thicker wall. Meanwhile, the EJV and IJV systems have similar dissection characteristics. Therefore, cephalic-EJV system and radial-IJV system anastomosis might be more consistent with general physiological conditions. Second, the two separate vein systems can complement each other because regardless of which vein has inadequate outflow, the other system can still function. For example, we observed an abnormal color change in one of the flaps in group 2. Half of the flap, which was governed by the cephalic vein, had an unusual color, while the other half seemed normal. This phenomenon improved without any intervention the next day. We think there might have been compression of the cephalic vein, but the blood then flowed into the radial vein through the perforating vein, which rescued the flap. Although we have to make efforts to avoid any kind of technical error, accidents happen, which are beyond our control. Some factors might cause thrombosis in the IJV include pedicle positioning, traction of the IJV, thermal injury, hypercoagulation, etc [21]. Therefore, we recommend double vein anastomosis, especially in those who are too weak to withstand secondary salvage surgery, because it optimizes the consequences caused by unknown risks and undetached drawbacks. Using both the IJV and EJV system veins would be more favorable.