Arteriovenous Fistula Formation in Vessel-Depleted Necks: Review of the Literature

Wednesday, October 4, 2023

11:18 AM - 11:24 AM East Coast USA Time

Location: 205ABC

Presenting Author(s)

Leyn B. Shakhtour, BS

Medical Student
George Washington University School of Medicine and Health Sciences
Washington, District of Columbia, United States
Alejandro R. Velasquez, BS

Medical Student
Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences
Washington, DC, United States

Co-Author(s)

Timothy Brandon Shaver, MD

Resident
Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences
Capitol Heights, MD, United States

Co-Author(s)

Timothy Brandon Shaver, MD

Resident
Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences
Capitol Heights, MD, United States
Weston L. Niermeyer, MD

Resident Physician
George Washington University
Washington, DC, United States

Senior Author(s)

AJ

Arjun S. Joshi, MD

Professor of Surgery
The George University Medical Faculty Associates, Department of Otolaryngology
Washington, DC, United States
Tom Shokri, MD

Resident Physician
Penn State Hershey Medical Center -Department of Surgery - Division of Otolaryngology
Hershey, Pennsylvania, United States

Disclosure(s):

Alejandro R. Velasquez, BS: No relevant relationships to disclose.

Weston L. Niermeyer, MD: No relevant relationships to disclose.

Arjun S. Joshi, MD: No relevant relationships to disclose.

Introduction: Prior surgery and radiation to the head and neck can result in loss of adequate vasculature and availability of recipient vessels for future reconstructive procedures, thereby creating “vessel-deplete necks” (VDN). Formation of an arteriovenous fistula (AVF) has been proposed to overcome this barrier but its use has been limited to small case reports and series; this study aims to review the current literature on AVF outcomes in patients with VDNs.

Methods: A search strategy was created to identify registered literature in Pubmed, Scopus, and Cochrane. Using Covidence, articles which reported AVF formations in VDNs were screened by three reviewers based on inclusion criteria. Conflicts were resolved through discussion and unanimous agreement. Data from the studies that underwent full text review were extracted to a shared spreadsheet. Variables studied included patient demographics, surgical indication, surgical approach, donor and recipient vessels used, type of flap and graft used, and surgical complications. Data was analyzed using the statistical software package SPSS 22.0 (SPSS, Inc., Chicago, IL) to conduct frequencies and Fisher exact tests.

Results: 36 individual cases from 12 studies fulfilled eligibility criteria for analysis. Of these 36 cases, 91.7% had a free flap success rate, 55.6% were male, the most common surgical indication was a combination of surgery and radiation (50%, n=18), and the most utilized graft was the saphenous vein (88.9%, n=32). The most common flap used was the fibula free flap (22.2%, n=8). 61.1% (n=22) of the cases used a single-staged surgical approach with a lower free flap failure of 9.1% (n=2). The most common complication was thrombosis in the grafted vein and pedicle 19.4% (n=7).

Conclusions: Our review offers insight into reported indications, techniques, and outcomes for VDN patients undergoing AVF. We support evidence that adequate free flap success rates were reached, comparable to the success of primary free flap transfer. Our ability to conduct in depth statistical analysis was limited by the small sample size. Further prospective studies are needed.