Superficialization of the outflow vein in case of a cubital fistula always or sometimes?

Introduction: The hemodialysis treatment requires an outflow vein from an arterio-venous fistula which is easily accessible and suitable for multiple venepunctures. The increasing number of elderly patients, those overweight and those with diabetes mellitus, has led to increased number of primary cubital anastomoses. The purpose of this study was to show our attempt to superficialize the outflow vein (s) in patients with difficult venipuncture after a previously constructed native cubital fistula. Materials and method: The data set is comprised of 442 arterio-venous anastomoses performed within a 5-year period (from 1st July 2011 until 30th June 2016) in the Clinic of Nephrology and Dialysis at Medical University, Pleven, Bulgaria. The primary cubital fistulas constitute 311 (70%) of all cases. Consecutive superficialization of the outflow vein was performed in 18 cases (6%). Results: No case of complications was recorded-neither during the intervention, nor afterwards, when the fistula was used. One-year patency of the fistula was observed in 17 patients (94%). The surgery has been successful (comfortable access for puncture area) in 17 cases (94 %). Conclusions: According to the data presented by us, the planned superfluidisation of the outflow vein(s) in cubital anastomoses shows good perioperative and one-year survival. It may be observed in patients with difficult-to-puncture veins and we recommend using it more often in practice. This intervention improves the quality of treatment in patients undergoing hemodialysis.