SUCCESSFUL ARTERO VENOUS FISTULA USING CARDICA C-PORT xA SYSTEM IN AN ELDERLY UREMIC PATIENT. A CASE REPORT.

Abstract

INTRODUCTION AND AIMS: In artero venous fistula (AVF) hand-sewn anastomoses are considered the gold standard. These are performed generally with a double running suture. These suturing techniques yeld excellent results, despite being time-consuming, difficult to perform with small vessels, and associated with a significant learning curve. These device are intented to enable rapid, precise and reliable anastomoses in AVF without artery cross-clamping. METHODS: We report the case of a male 65 years old uremic patient with serious atherosclerosis that, in local anesthesia, underwent proximal AVF by mechanical anastomosis between cephalic vein and radial artery without arterious cross-clamping. This is possible with the assistance of the Cardica C-Port xA System (Cardica , Inc, Redwood City,CA) a new device first used in coronary artery by-pass. The C-port device integrates in one tool all functions necessary to enable rapid automated side-to-end-anastomoses between the artery and the vein ( Figure 1). RESULTS: The total surgical time was 25 minutes. The connection between the artery and the vein was performed rapidly ( 10 seconds ), without the need for temporary occlusion of the artery. The thrill was present immediately after the anastomosis without bleeding from suture side CONCLUSIONS: The potential advantages of using this device include the ability to produce precise and fast anastomoses in a standardized fashion that requires minimal training. In uremic patients with severe atherosclerosis the lack of artery cross-clamping can reduce the intimal damages and AVF thromboses. Furthermore, adequate follow-up is necessary, because long patency of AVF with the C-Port xA is unknown.