Background and aim: Arterio-venous fistula (A-V fistula) in the snuff-box region is one of the current fistulization techniques in patients undergoing dialysis. The aim of this study was to find out the efficacy and side effects of distal vein ligation in arterio-venous fistulas of the snuff-box region in chronic renal failure patients.Methods: In this clinical-trial study, 60 patients (30 males, 30 females) suffering from chronic renal failure who had been admitted for fistulization, were randomly divided into two groups. In group 1, the distal part of vein was ligated after the A-V fistulization. In group 2, the distal part of vein was not ligated. Patients were assessed for the efficacy and the complications of distal vein ligation 1 day, 30 days and 90 days after the surgery. Data were analyzed by student's t-test and Chi-square test.Results: Early efficiencies in the ligated and non-ligated groups were 100% and 96.7% and late efficiencies were 90% and 83.4%, respectively (p<0.05). Thrombosis was the most common complication (11.7%) in both groups (P<0.05). Venous hypertension and edema were observed in two patients (both from the non-ligated group) and the infection of the surgical site was observed in only one patient.Conclusion: Considering the high efficiency and low complication rate, A-V fistulas of the snuff-box region are of preferred possible vascular methods for hemodialysis patients. Ligation of the distal part of vein prevents occurring venous hypertension in the fistula.

Background: Endogen arteriovenous fistulas (AVFs) are one of important hemodialysis access. According to current use of this technique, especially snuff box AVF, we compared the efficacy and complications of the two main techniques of snuff box AVFs, including with distal vein ligation and without ligation the vein.Materials and methods: This double blind clinical trial was performed on 110 (11 to 83 years old) chronic renal failure (CRF) patients without evidence of proximal vein stenosis. Case and control group were matched regarding in age, sex, underlying disease and history of previous AVF. Vein distal to the site of AVF was ligated in case group and left open in control group. Patients were followed up in the days 1, 30, and 180 after the surgery to evaluate the efficacy and complications of two techniques.Results: Short-term efficacy was 90% and 93.6% in case and control groups, respectively. Long-term efficacy was 90% in case group and 84.8% in control group (NS). The most common complication in both groups was thrombosis followed by edema of the limb and venous hypertension. Venous hypertension was seen only in the control group (NS).Conclusion: There are no statistical significant differences between two groups in efficacy and complications. Venous hypertension did not occur in any of the patients in case group. So, we recommend distal ligation of vein in snuff box AVFs.

BACKGROUND: The feasibility and safety of coronary angiography (CAG) and angioplasty via trans-snuffbox approach (TSA) is still concerned; therefore, in this study, we aimed to assess possible complications occurring after TSA versus trans-radial approach (TRA). METHODS: This prospective observational study was undertaken from June 2017 till March 2018. Individuals aged at least 18 years who were admitted for CAG through upper extremity were eligible and categorized to TSA (n = 70) and TRA (n = 56) groups. Occurrence of complications including hematoma, pain or paresthesia, pseudoaneurysm formation, arterial obstruction, limb ischemia, and major adverse cardiovascular events (MACE) including death, myocardial infarction (MI), stroke, and emergency vessel revascularization was assessed after the procedure and in two separate visits three and six months afterwards. RESULTS: The mean age of participants in TSA and TRA groups was 55. 1 ± 9. 7 and 56. 5 ± 9. 6 years, respectively (P = 0. 415). Men were the dominant group in both approaches [TSA: 44 (62. 8%), TRA: 36 (64. 3%), P = 0. 868]. Success rates in TSA and TRA were 88. 6% and 94. 6%, respectively (P = 0. 230). Radial artery occlusion (RAO) was reported in two (3. 2%) and one (1. 8%) case in TRA and TSA, respectively (P = 0. 653). MACE incidence was not significantly different in TSA compared with TRA group (1. 8% vs. 4. 8%, respectively, P = 0. 389). There was no major procedural complication, neither in TSA nor in TRA category. CONCLUSION: Our results revealed that TSA could be classified as an alternative modality to other common CAG and angioplasty methods due to its high safety rate and lower complications. Several comprehensive population-based studies are necessary for confirming these findings.

BACKGROUND: Trans-radial and trans-ulnar accesses have been practiced and recommended as default and alternative techniques for coronary angiography and angioplasty in recent years. In this study, we present new innovative approaches using more distal access points, i. e. transsnuff box and trans-palmar approaches. METHODS: We conducted dorsal hand access (trans-snuff box) for angiography and/or angioplasty on 235 patients, and trans-palmar access (superficial palmar branch of ulnar artery) on 175 patients in 3 hospitals in Isfahan City, Iran. RESULTS: In 221 patients out of 235 ones (94. 1%) [men: 76. 5%, age: 57. 4 ± 10. 4 (years); women: 23. 5%, age: 62. 4 ± 9. 5 (years)], our procedure through snuff box (dorsal hand) was successfully performed. In 159 patients out of 175 ones (90. 8%) [men: 76. 0%, age: 58. 1 ± 10. 5 (years); women: 24. 0%, age: 61. 2 ± 9. 6 (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (3. 4% for snuff box, and 4. 5% for palmar), ecchymosis in distal forearm (5. 1% for snuff box, and 2. 8% for palmar), with no major complications even one (amputation, infection, thrombosis, need for surgery, hand dysfunction, nerve palsy, and so forth). In addition, percutaneous coronary intervention (PCI) was done in 28. 9% and 18. 2% of cases via snuff box and palmar approaches, respectively. Meanwhile, hemostasis was very fast and easy with discharge time equivalent to other upper limb accesses. CONCLUSION: Although our procedures are at their early stages with about a follow-up period of 3-15 months, more researches are recommended to be conducted in forthcoming months and years, and this new innovative approaches could be suggested safe, feasible, and reliable with low complications.

Radial artrey is one of the two terminal branches of brachial artery. It descends along the lateral side of the foream to the wrist where it curls posterolaterally round the carpus, deep to the snuff box, to reach the proximal end of the first intermetcarpal space where it dips in the palm and crosses medially to form the deep palmar arch with the deep branch of the ulnar artery. In the process of the dissection in this department , a very rare case of the complex variations was observed in the route and branches of radial artery in the right hand of a male cadaver: a) Crossing of the radial artery on the superficial part of the snuff box b) Bifurcating of it before dipping into the palm c) Arising of the princips pollicis and radilais indicis from superficial palmar arch.