Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.190077
Jornal Vascular Brasileiro
Original Article

Transposição da veia braquial como acesso para hemodiálise: uma alternativa ao uso de prótese sintética

Brachial vein transposition: an alternative to hemodialysis arteriovenous graft

Guilherme de Castro-Santos; Alberto Gualter Salles; Giuliano Silva dos Anjos; Ricardo Jayme Procópio; Túlio Pinho Navarro

http://dx.doi.org/10.1590/1677-5449.190077 J Vasc Bras, vol.18, e20190077, 2019
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Resumo

Resumo: Contexto: Atualmente, observa-se um esforço mundial para aumento do número de acessos autógenos para hemodiálise.

Objetivos: Avaliar a perviedade e as complicações da transposição da veia braquial em comparação aos outros acessos autógenos para hemodiálise.

Métodos: Avaliação retrospectiva de 43 pacientes, com 45 procedimentos. Os pacientes que não apresentaram veias do sistema venoso superficial adequadas ao Duplex Scan pré-operatório foram submetidos à transposição da veia braquial. Esses procedimentos foram divididos em dois grupos: A: uso da veia braquial, n = 10. B: demais acessos, n = 35.

Resultados: Não houve diferença estatística entre os grupos no que se refere à idade, diabetes, hipertensão arterial sistêmica, dislipidemias, arteriopatias, neoplasias, estágio da doença renal, diâmetro da artéria doadora e da veia receptora, pressão arterial sistólica no membro operado, isquemia pós-operatória, formação de hematoma e infecção. Não houve diferença quanto à perviedade aos 7 dias A: 80% vs. B: 90%, p = 0,6; aos 30 dias A: 80% vs. B: 86%, p = 0,6; e aos 60 dias A: 60% vs. B: 80%, p = 0,22. Houve diferença entre os grupos quanto ao número de fístulas prévias A: 1,0 ± 0,44 vs. B: 0,6 ± 0,3, p = 0,04; e quanto ao edema em membro superior A: 20% vs. B: 0%, p = 0,04. A veia doadora menor que 3 mm esteve associada ao maior risco de oclusão precoce (RR = 8, p = 0,0125). Nesse período, não houve nenhum procedimento com o uso de prótese sintética.

Conclusões: A veia braquial transposta é uma alternativa à prótese sintética.

Palavras-chave

veia braquial, prótese, fistula first, artéria braquial, aceso para hemodiálise, fístula arteriovenosa

Abstract

Abstract: Background: There is currently a worldwide effort to increase the options for autogenous hemodialysis access.

Objectives: To evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses.

Methods: A retrospective evaluation of 43 patients and 45 procedures. Patients who did not have adequate superficial veins according to duplex scanning were allocated to brachial vein transposition. The sample was thus divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35.

Results: There were no statistical differences between the two groups in terms of age diabetes, systemic arterial hypertension, dyslipidemias, arteriopathies, neoplasms, kidney disease stage, donor artery diameter, recipient vein diameter, systolic blood pressure in the operated limb, postoperative ischemia, hematoma, or infection. There were no statistical differences in terms of patency on day 7: A 80% vs. B 90% p=0.6, on day 30: A 80% vs. B 86% p=0.6, or on day 60: A 60% vs. B 80% p=0.22. There were statistical differences between the groups for number of previous fistulae A 1.0 ± 0.44 vs. B 0.6 ± 0.3 p = 0.04 and upper limb edema A: 20% x B 0% p = 0.04. A vein with diameter of less than 3 mm was associated with an increased risk of early occlusion (RR = 8 p = 0.0125). During the study period there were no procedures using grafts.

Conclusions: Transposition of brachial vein is an alternative to arteriovenous graft.
 

Keywords

brachial vein, graft, fistula first, brachial artery, hemodialysis access, arteriovenous fistula

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