A large-scale study of the upper arm basilic transposition for hemodialysis.

The incidence of stage 5 chronic kidney disease requiring immediate hemodialysis treatment continues to rise with an increasing number of patients with an unsuitable cephalic vein or failed radio- and brachiocephalic fistulae. In these patients the basilic vein is our next autologous choice. We have previously investigated our preliminary experience and identified common failure modes, and this report describes longer-term outcomes and what we feel are results after the learning curve has been surmounted. All patients who underwent basilic vein transposition from April 2001 to June 2008 at our institution were retrospectively reviewed. Data collected included demographics, anesthesia type, volume flow at creation, maturation rate, patency rates, post-operative complications, secondary interventions (endovascular and open surgical revision), and overall mortality. Two hundred seventeen upper arm basilic vein transposition fistulae were created in 215 patients (53% male). Prior to basilic transposition, patients had a mean of 2.9 previous surgical access attempts. Only 14% of patients had a basilic vein transposition as their initial fistula. Mean flow at time of fistula creation was 347 (range 10-880) mL/minute, with a maturation rate of 87%. The procedural mortality rate was 0.5%. Primary and primary assisted patency rates at 6, 12, and 24 months were 63%, 40%, and 26% and 74%, 56%, and 38%, respectively, while secondary patency rates at 6, 12, and 24 months were 85%, 72%, and 65%, respectively. Fistula thrombosis was the most common complication prior to maturation (16%). Central vein stenosis (22%) was the most frequent cause of fistula failure. Basilic vein transposition fistulae have excellent initial maturation rates (87%) with reasonably good functional (secondary) patency rates (72% at 1 year). Central venous stenosis is a major postmaturation limiting factor in long-term durability, and revisions are frequent. The optimal order of access in patients without usable cephalic veins remains a difficult challenge, but basilic vein transposition seems to stack up well versus prosthetic grafts in this situation.

Glass C ，Porter J ，Singh M ，Gillespie D ，Young K ，Illig K ... -  《-》

Superficialization of the basilic vein technique in brachiobasilic arteriovenous fistula: surgical experience of 350 cases during 4 years period.

The primary use of autogenous arteriovenous fistula for chronic hemodialysis patients is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines (Am J Kidney Dis 2001;37(1 Suppl. 1):S7-S64; Am J Kidney Dis 1997;30(4 Suppl. 3):S150-S191). Brachiobasilic arteriovenous fistula offers excellent access in difficult cases. Many surgical techniques have been described to create brachiobasilic fistula. The purpose of this study was to present and discuss the technique of superficialization of the basilic vein in brachiobasilic arteriovenous fistula with long-term results of 350 cases. A total of 375 brachiobasilic arteriovenous fistulas were constructed with superficialization of the basilic vein technique. Of these, 350 fistulas were used in hemodialysis (93.3%). One hundred fifty-five (44%) patients were male, 195 (56%) were female. Mean age was 57.8 (range, 18-88) years. A 2-cm longitudinal incision was made in antecubital fossa to expose brachial artery and basilic vein under local anesthesia. A separate second skin incision (4-6 cm) was done to explore proximal part of the basilic vein. Side branches of the basilic vein were isolated and ligated carefully using this second skin incision. The basilic vein was divided in antecubital fossa and brought over the fascia through the subcutaneous tunnel at the same anatomical position. Anastomosis was performed with end-to-side technique. Mean follow-up was 48 months (range, 2-84). The mean time to first puncture and use of the fistula time was 52 days (range, 25-75). Bleeding required surgical exploration which occurred in 3 (0.9%) patients. Primary patency of basilic vein superficialization fistulas was 92%, 78%, 64%, and 54% at 1, 2, 3, and 4 years, respectively. Secondary patency was 93%, 81%, 66%, and 56% at 1, 2, 3, and 4 years, respectively. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition. Superficialization requires less extensive skin incision and surgical dissection. Long-term patency was good.

Korkut AK ，Kosem M 《-》

Equivalent secondary patency rates of upper extremity Vectra Vascular Access Grafts and transposed brachial-basilic fistulas with aggressive access surveillance and endovascular treatment.

Kakkos SK ，Andrzejewski T ，Haddad JA ，Haddad GK ，Reddy DJ ，Nypaver TJ ，Scully MM ，Schmid DL ... -  《JOURNAL OF VASCULAR SURGERY》

Relationship of preoperative venous and arterial imaging findings to outcomes of brachio-basilic transposition fistulae for hemodialysis: a prospective clinical study.

Karakayali FY ，Sevmis S ，Basaran C ，Yabanoglu H ，Arat Z ，Boyvat F ，Haberal M ... -  《-》

Comparison of the efficacy of upper arm transposed arteriovenous fistulae and upper arm prosthetic grafts.

Woo K ，Doros G ，Ng T ，Farber A ... -  《-》