Abstract
BackgroundThere is currently a worldwide effort to increase the options for autogenous hemodialysis access.ObjectivesTo evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses.MethodsA retrospective evaluation of 43 patients and 45 procedures. Patients who did not have adequate superficial veins according to duplex scanning were allocated to brachial vein transposition. The sample was thus divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35.ResultsThere were no statistical differences between the two groups in terms of age diabetes, systemic arterial hypertension, dyslipidemias, arteriopathies, neoplasms, kidney disease stage, donor artery diameter, recipient vein diameter, systolic blood pressure in the operated limb, postoperative ischemia, hematoma, or infection. There were no statistical differences in terms of patency on day 7: A 80% vs. B 90% p=0.6, on day 30: A 80% vs. B 86% p=0.6, or on day 60: A 60% vs. B 80% p=0.22. There were statistical differences between the groups for number of previous fistulae A 1.0 ± 0.44 vs. B 0.6 ± 0.3 p = 0.04 and upper limb edema A: 20% x B 0% p = 0.04. A vein with diameter of less than 3 mm was associated with an increased risk of early occlusion (RR = 8 p = 0.0125). During the study period there were no procedures using grafts.ConclusionsTransposition of brachial vein is an alternative to arteriovenous graft.
Highlights
An autogenous arteriovenous fistula using superficial forearm veins is the first choice for hemodialysis access because of its greater patency, lower rate of infection and lower morbidity and mortality.[1,2]
Patients were divided into two groups, as follows, Group A: brachial vein transposition, with 10 procedures; and Group B: other types of access, with 35 procedures
Notwithstanding its retrospective nature and the limited number of patients, in this study use of the transposed brachial vein was associated with similar results to other autogenous arteriovenous fistula methods using the customary superficial veins
Summary
An autogenous arteriovenous fistula using superficial forearm veins is the first choice for hemodialysis access because of its greater patency, lower rate of infection and lower morbidity and mortality.[1,2] The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends that at least 65% of patients should have an autogenous arteriovenous fistula for access.[3]Chronic kidney disease requiring dialysis is a serious condition with high mortality and its prevalence is growing exponentially in Brazil. An autogenous arteriovenous fistula using superficial forearm veins is the first choice for hemodialysis access because of its greater patency, lower rate of infection and lower morbidity and mortality.[1,2] The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends that at least 65% of patients should have an autogenous arteriovenous fistula for access.[3]. Infections related to central venous catheters and synthetic grafts contribute to the high sepsis rates.[4] Strategies to increase use of autologous veins to construct arteriovenous fistulas for hemodialysis are increasingly encouraged. Objectives: To evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses. The sample was divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35. Conclusions: Transposition of brachial vein is an alternative to arteriovenous graft
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