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High Brachial Artery Bifurcation: Clinical Considerations and Practical Implications for an Arteriovenous Access
Author(s) -
Kian Kaveh,
Shapiro Joshua A.,
Salman Loay,
Khan Rao Ali Hashim,
Merrill Donna,
Garcia Leonel,
Eid Nadia,
Asif Arif,
Aldahan Adam,
Beathard Gerald
Publication year - 2011
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2011.00964.x
Subject(s) - medicine , brachial artery , arteriovenous fistula , elbow , hemodialysis access , hemodialysis , incidence (geometry) , kidney disease , vascular access , radiology , surgery , cardiology , blood pressure , physics , optics
High brachial artery bifurcation (HiBAB) is not a rare occurrence. Recent data have emphasized that HiBAB can have major clinical implications including high failure rate and decreased functional patency of an arteriovenous (AV) fistula. In this retrospective study, we investigated the incidence of HiBAB. Patients with advanced chronic kidney disease and end‐stage renal disease on chronic hemodialysis undergoing preoperative vascular mapping for the creation of an AV access were included in this analysis. Ultrasound examination was used to map the arteries of the upper extremities. Four hundred and eighty‐one arms in 340 patients were examined (right arm = 181, left arm = 300). Sixty‐nine of the 481 (12.3%) demonstrated HiBAB. The internal diameter of the radial and ulnar arteries measured at the elbow region was found to be 2.9 ± 0.8 and 3.6 ± 1.0 mm, respectively ( p  = 0.0001). There were no statistically significant differences in terms of race, gender, and right versus left arms regarding the incidence of HiBAB. As HiBAB can be present in a significant number of patients and have an impact on the AV access, its presence should be evaluated during vascular mapping prior to an AV access creation.

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