Arteriovenous Fistula Creation through Basilic Vein Transposition in an Upper Extremity

Song, Dan; Moon, Chul

Abstract

PURPOSE: Autogenous arteriovenous access for chronic hemodialysis is recommended by the National Kidney Foundation- Dialysis Outcomes Quality Initiative practice guidelines. A transposed basilic vein to brachial artery arteriovenous fistula provides secondary vascular access for hemodialysis we assess outcomes of basilic vein transposition in arteriovenous fistula in this retrospective series.
METHODS
We performed a retrospective review of 81 patients undergoing basilic vein transposition (BVT) in the Soonchunhyang University College of Medicine between January 2000 and December 2006. Age, sex, etiology of end-stage renal disease, and complications were tabulated. Primary and secondary patency rates were determined using Kaplan-Meier methods.
RESULTS
The average age was 58 years old and 43 patients were male. Renal failure was associated with hypertension in 59 patients (73%), diabetes in 30 patients (37%), and BVT was the primary access procedure in 19 patients (23%). Follow-up was between 12 to 84 months. There was no operation-related deaths. Seven patients required prosthetic graft interposition because of shortness of the basilic vein. Primary and secondary patency rates were 74% and 93%, respectively, at 1 year, and 73% and 87% at 2 years. Thirty five postoperative complications developed in 21 patients, including thrombosis (1), proximal vein stenosis (17), arm swelling (1), central vein stenosis (10), bleeding with hematoma (1), wound seroma (2), steal syndrome (2) and aneurysm (1). The seven patients who required subsequent prosthetic grafting for a failed basilic vein arteriovenous fistula had an ipsilateral procedure.
CONCLUSION
BVT arteriovenous fistula techniques provide a good patency rate. The complication rate, although high, is lower than that reported for PTFE grafts. Chronic renal failure with hemodialysis patients might benefit from BVT, because of long patency, less radiologic procedure, and lower infection rates. The BVT fistula should be used in preference to PTFE grafts for secondary access.