IFT05. Outcomes of Basilic Vein Transposition: Challenges in an Indian Setting

Abstract

Basilic vein transposition (BVT) is performed after other native access options are exhausted. Based on the numbers that we perform and vein maturation, we would expect good patency. The objective of this study was to understand the patency of BVT in our practice and the adequacy of surveillance. This was a retrospective study. All patients who underwent BVT between January 2015 and December 2016 were included. Patients who did not attend follow-up clinic were contacted by telephone. Data regarding patient demographics, previous vascular access, dialysis status, postoperative complications and patency (primary, primary assisted and secondary patency rates) at one year and two-year intervals were collected. There were 126 BVTs performed in 125 patients. Mean age of patients was 53 years (range, 16-82 years) and 78 patients (62.4%) were male. All patients had multiple failed native arterial fistulas before BVT. Two patients were in predialysis status and the others were on dialysis using tunneled central lines. BVT was performed as single-stage procedure in all patients. Three patients (2.4%) died and one patient underwent renal transplant within the first 30 days. Only 18% of the patients attended the scheduled follow-up visits. Of 122 procedures, 115 (94.3%) resulted in a mature fistula. At the 1-year follow-up, 38 patients were lost, 19 patients were dead, and 4 patients had renal transplant. At 1 year there were 65 (52%) eligible patients for analysis, of which 8 patients had ligation of the transposed basilic vein for pseudoaneurysm/bleeding complications and the primary patency was 49.2%, primary-assisted patency 56.9%, and secondary patency was 66.1%. At 2 years an additional 10 patients died and 3 patients had renal transplant. At 2 years there were 52 eligible patients (41%) for analysis, out of which the primary patency was 38.5%, primary-assisted patency was 42.3%, and secondary patency was 59.6%. Surveillance was inadequate because patients were being dialyzed at other centers and in other cities. Dialysis technicians and nurses often failed to recognize failing fistulas. BVT can be performed safely with good maturation in majority of the patients. However, inadequate surveillance and maintenance of fistulas can result in reduced 1- year and 2-year patency rates. A patient-centered approach with communication and education of patients, dialysis technicians, nephrologists and vascular surgeons could improve the patency rates.