The Brachial Artery-basilic Vein Arterio-venous Fistula in Vascular Access for Haemodialysis—A Review Paper

Abstract

Aims To review the available literature regarding patency rates and complications of the brachial-basilic arterio-venous fistula (BBAVF) and to discuss this with relation to the current dialysis outcomes quality initiative guidelines. Methods An internet based literature search was performed using Pubmed, Medline and Medscape databases to identify all published reports of the BBAVF in the English language from which the full articles were retrieved and cross-referenced. Results Of 136 papers identified, 28 were directly relevant to this review including four prospective studies (one randomised trial, three non-randomised trials) and 24 retrospective studies. First described by Dagher in 1976, the BBAVF has since been modified to a two-stage procedure with initial fistula formation followed by superficialisation of the basilic vein 6 weeks later. It can be formed successfully in 95% of cases. Mean 1-year primary and secondary patency rates were 72 and 74.6%, respectively. Complications included haematoma (3.8%), stenosis (2.3%), thrombosis (9.7%), transient arm oedema (3.7%), steal syndrome (2.9%) and aneurysm/pseudoaneurysm formation (1.9%). The BBAVF had a lower rate of infection than prosthetic fistulas (3.6 vs. 16%). Conclusions The BBAVF has good primary and secondary patency rates with lower rates of infection than prosthetic fistulas making it a preferred secondary access procedure.