The sleeve method for creation of radiocephalic arteriovenous fistulas in patients with calcified vessels



Creation of an arteriovenous fistula (AVF) in patients with advanced atherosclerotic changes of the artery is often a challenge for the physician due to difficulties in suturing the vein to the side of the frangible artery. The sleeve technique relies on advancing the end of the artery into the lumen of the vein and protecting the anastomosis by adventitial sutures.

Material and methods

The sleeve technique was performed in 23 patients with chronic kidney disease stage IV and V and included hemodialysis patients. Their mean age was 60.8 ± 14.8 years and hemodialysis treatment time 49.8 ± 40.2 months. The most frequent causes of chronic kidney disease are ischemic nephropathy (43%, n = 10) and type l diabetes (21%, n = 5). Only patients with extremely advanced atherosclerotic were recruited and analyzed.


The primary patency rate was 67%, 59%, 44% and 28% at 6, 12, 24, and 36 months, respectively. The secondary patency rate was 67%, 61%, 50% and 37% at 6, 12, 24, and 36 months, respectively. In three patients the AVF failed directly after the operation. Delayed fistula failure occurred in seven patients. The overall success in the creation of a functioning fistula was achieved in 15 of the 23 patients (65%). No serious complications were observed.


In patients with calcified atherosclerotic plaques, which constitute a barrier or make it difficult to suture the vein to the side of the artery, the sleeve method may be considered as an alternative before abandoning the creation of a fistula on the forearm. The technique is much simpler than the standard end-to-side or side-to-side anastomosis.

J Vasc Access 2017; 18(5): 384 - 389




Tomasz Gołębiowski, Wacław Weyde, Krzysztof Letachowicz, Mariusz Kusztal, Hanna Augustyniak-Bartosik, Jan Penar, Katarzyna Madziarska, Sławomir Zmonarski, Magdalena Krajewska, Marian Klinger

Article History


Financial support: No grants or funding have been received for this study.
Conflict of interest: Wacław Weyde is an employee of Fresenius Medical Care. None of the authors has financial interest related to this study to disclose.

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  •  Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw - Poland
  •  Fresenius Medical Care Polska, Poznań - Poland

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