PMC7305356_01
The photo illustrates the surgical technique of a radial artery-second dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the dorsal hand. (A) The radial artery (red line), second dorsal metacarpal vein (blue line), tendon of the extensor pollicis longus (black line), and skin incision line (black dashed line) were preoperatively indicated using markers. (B) A longitudinal 1.5-cm skin incision was made along the slight ulnar side of the artery, and an approximately 3-cm segment of the vein and an approximately 2-cm segment of the artery were dissociated. (C) After 2000 units of heparin were administered and allowed to circulate for 5 min, the distal part of the vein was ligated and excised proximal to the ligation. (D) An end-to-side arteriovenous fistula was created between the vein and the artery. RA: radial artery, SDMV: second dorsal metacarpal vein, EPL: extensor pollicis longus.
gr1.jpg
PMC7305356_01_gr1.jpg
fig0005
Thirteen days after his admission, the operation was successfully performed (Fig. 1A-D). The radial artery, SDMV, tendonof the extensor pollicis longus, and skin incision line were preoperatively indicated using markers (Fig. 1A). Next, an approximately 3-cm segment of the vein was dissociated to reach and anastomose with the artery, and an approximately 2-cm segment of the artery was dissociated (Fig. 1B). After 2000 units of heparin were administered and allowed to circulate for 5 min, the distal part of the vein was ligated and transected proximal to the ligation (Fig. 1C). An end-to-side AVF whose anastomotic diameter was approximately 8 mm was then created using continuous 7/0 polypropylene sutures (Fig. 1D), and a good thrill was confirmed.
(A) A mature radial artery-second dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the left dorsal hand in the present case. (B-C) Venipuncture sites during hemodialysis. Blood-removal sites: white arrows. Blood-retransfusion sites: black arrows. (D) A schematic illustration of the arteriovenous fistulas in the left dorsal hand and forearm in the present case.
gr2.jpg
PMC7305356_01_gr2.jpg
fig0010
The AVF had developed sufficiently (Fig. 2A), and the blood flow rate during hemodialysis (QB) exceeded 300 mL/min. The venipuncture sites are shown in Fig. 2B-C, and a schematic illustration of the AVF in the patient's left hand and forearm is shown in Fig. 2D.