Dialysis access surgery: Brescia-Cimino (radiocephalic) fistula – Vascular surgery

Inject about 5 ml of prilocaine (Xylonest®) 1% into the distal left forearm between the cephalic vein and radial artery.

Fashion an approximately 3 cm long longitudinal incision between radial artery and cephalic vein. Dissect and isolate the vein in the subcutaneous plane. Initially preserve the continuity of the shunt vein to protect its endothelium.

Tip:

Note the switch to atraumatic forceps at the start of the vessel dissection.

Make a radial incision into the connective tissue of the sheath and expose the radial artery. Encircle the artery centrad and distad with vessel loops.

Tip:

Make sure to protect the dorsal branch of the radial nerve, which runs to the anatomical snuff-box.