Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population.

Koy Min Chue,Kyi Zin Thant,Hai Dong Luo,Yu Hang Rodney Soh,Pei Ho

doi:10.1155/2016/8693278

Abstract

Aim. For patients who have exhausted cephalic vein arteriovenous fistula (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the outcomes of these two modalities. Methods. A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81) or an AVG (41). Maturation time and intervention rates were analyzed. Functional primary, secondary, and overall patency rates were evaluated. Results. The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% versus 34.1% (p < 0.001) and 71.8% versus 54.3% (p = 0.022), respectively. AVGs also required more interventions to maintain patency. When maturation rates were considered, the overall patency of AVGs was initially superior in the first 25 weeks after creation and then became inferior afterwards. Conclusion. BBTAVFs had superior primary and functional patency and required less salvage interventions. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

Highlights

Hemodialysis remains the commonest mode of renal replacement therapy for end stage renal disease patients (ESRD) worldwide
We aim to review the performance of the brachial-basilic transposition arteriovenous fistula (BBTAVF) and forearm brachial-basilic arteriovenous graft (AVG) (BB AVGs) of Asian patients with only basilic veins suitable for vascular access in our institution
Several studies have favoured the BBTAVF over the forearm loop BB AVG procedure on the basis of better patency rates and fewer interventions [5, 6, 15]. These studies report only the outcomes from accesses that were successful initially and primary failure cases were excluded from the analysis. This might result in an overestimation of the successes of BBTAVFs compared to BB AVGs, as they failed to take into account issues with access creation and maturation

Summary

Introduction

Hemodialysis remains the commonest mode of renal replacement therapy for end stage renal disease patients (ESRD) worldwide. The Kidney Disease Outcome Quality Initiative (KDOQI) guidelines recommended autogenous arteriovenous radiocephalic (RC AVF) or a brachiocephalic fistula (BC AVF) as the first-line options for vascular access [2]. Due to various reasons, such as either a lack of suitable cephalic veins [3] or failed cephalic vein arteriovenous fistulas (AVF), some patients are unable to achieve hemodialysis via the cephalic vein AVF. For such patients who only have favourable basilic veins over the elbow region, the vascular access strategies will include a brachial-basilic transposition arteriovenous fistula (BBTAVF) or a forearm loop arteriovenous graft (AVG) with either prosthetic or biosynthetic material [2]. Few studies addressed such differences in an Asian population

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