Long-term outcomes of basilic vein transposition fistula for hemodialysis

Abstract

There has been a dramatic increase in both the availability of hemodialysis and long-term survival of patients with chronic renal failure. Patients who require long-term hemodialysis need long-term vascular access. The transposed autologous basilic vein to brachial artery arteriovenous fistula provides vascular access in the absence of adequate superficial vein. We follow an aggressive "all-autogenous" policy with regard to dialysis access and recommend prosthetic graft when autogenous options are exhausted. A retrospective analysis was performed of consecutive patients who underwent basilic vein transposition for hemodialysis access between January 2000 and March 2004. Mean follow-up was 21 months (range, 4 to 32 months). A retrospective review of 42 patients undergoing basilic vein transposition was performed. 18 of the patients were men and 24 patients were women. The mean age was 34.6 +/- 12.9 (mean +/- SD) years. Most of the patients were already receiving hemodialysis (92%), with a mean of 2.2 (range, 1 to 4) previous access attempts. Maturation rate was 85.7%. Primary patency rates were 71.4%, 54.7% and secondary (overall) patency rates were 88.0%, 64.2% at the end of the first and second years, respectively. Complications developed in 23 (54.7%) cases, and included arm edema, thrombosis, hematoma, infection, steal syndrome, poor flow and aneurysm formation. Transposed brachial-basilic fistula have a good long-term patency rate and should be considered early, before prosthetic grafting, in the absence of a suitable superficial vein.