Forearm and Upper Arm Basilic Vein Transposition Arteriovenous Fistula for Patients Undergoing Hemodialysis
Keywords:
Vascular access surgery, Basilic vein transposition, HemodialysisAbstract
Objective: The aim of the present study was to evaluate the functional patency of the standard vascular access surgery and basilic vein transposition (BVT) arteriovenous fistula (AVF) in a single institution.
Methods: We reviewed cases of vascular access surgery performed between September 1, 2011 and August 31, 2019. Demographic and postoperative surveillance data were collected. BVT patients were either found unsuitable for or had failed any of the direct AVF options prior to transposition surgery.
Results: A total of 561 patients (325 men and 236 women) underwent vascular access surgery in the 9-year period. The mean age was 58.8 ± 14 years. The causes of chronic renal failure were diabetes (43%) and hypertension (86%). The mean follow-up duration was 28.6 ± 22.9 months. A total of 75 patients (41 men and 34 women) underwent BVT. The mean fistula maturation time was 1.9 ± 1.7 months in upper arm BVT and 2.6 ± 1.2 months in the forearm BVT. The maturation rate was 90% in the upper arm BVT and 86% in the forearm BVT. No bleeding, thrombosis, failure, pseudoaneurysm, or rupture occurred. The mean follow-up time in the BVT group was 31.6 ± 19.7 months. BVT functional patency assessed at 12, 24, and 36 months was 91%, 83%, and 72%, respectively, in the upper arm, and 76%, 51%, and 45%, respectively, in the forearm.
Conclusion: BVT is an alternative vascular access surgery with excellent initial maturation and patency rates, and should be considered in patients undergoing hemodialysis with primary failure of the fistula or naive veins not suitable for surgery. It is less expensive compared with the use of polytetrafluoroethylene grafts for secondary access.
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