USE OF HARMONIC SCALPEL FOR BRACHIO-BASILIC VEIN TRANSPOSITION IN AUTOGENOUS PROXIMAL ARTERIOVENOUS FISTULA

Objectives: This study evaluates the effectiveness and helpfulness of ultrasonic surgical device for atraumatic surgical dissection and hemostasis in brachio-basilic vein transposition. Since prosthetic grafts have been reached poor results and high costs, the primary use of autogenous AVF is recommended. Materials and Methods: From March 2004 to March 2009 67 cases (61 F ; 6 M; mean age 52 years) of brachio-basilic arteriovenous fistulae (BBAVF) were fashioned; in second stage, after vein maturation (about 30 days), we performed a superficial transposition of arterialized basilic vein by harmonic scalpel (UltracisionTM).. Results : On 67 cases of transposition of BBAVF 2 cases failed after 30 days, 1 case after 60 days. In March 2009 on 67 cases 54 have been included in the follow-up at one year and the cumulative patency rate was 82,25% respect to 61,7 % of the prosthetic grafts. Discussion: We prefer the two-staged technique because in the first stage, doing the fistula between humeral artery and basilic vein this reaches the maturation. So, in the second stage we works on an arterialized vein more resistant, it is easier to find collateral veins, and the dissection of the fistula from contiguous structures. Furthermore, the bigger vascular calibre at the moment of the second stage is a positive predictive factor of fistula survival. Conclusions: The use of the harmonic scalpel (Ultracision™) have improved the patency rate of the BBAVF. In fact we obtained a decreasing of the complications related to surgical dissection of the vein with better control of haemostasis, lower risk of vein and median nerve iatrogenic injuries. Moreover, by harmonic scalpel the operative time is reduced by an half respect to the intervention performed without. Finally, the lower costs and the positive preliminary studies encourage the use of this technique.