Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A 15-Year Overview.

Abstract

Distal forearm arteriovenous fistulas (AVFs) for hemodialysis (HD) include radiocephalic fistulas (RCFs) and ulnar-basilic fistulas (UBFs). However, due to the unique anatomical peculiarities of the latter approach, UBFs are only established in a limited subset of patients undergoing vascular access procedures. This study aimed to present a retrospective case series detailing the creation of UBFs, emphasizing both the technical challenges and clinical outcomes associated with this approach. We conducted a retrospective review of UBFs created between 2008 and 2023. Data collected included patient demographics, comorbidities, patency, functionality, and outcomes. Adequate blood flow and personalized Kt/Vurea levels were prerequisites for defining UBF functionality for HD. Among 253 patients receiving HD, 82.2% had an AVF, with only 3.3% (n = 5) of the 150 distal AVFs functional for HD being UBFs. In this series, a total of 11 UBF fistulas were created, with nine patients experiencing an immediate thrill. Among those with UBF failure, three patients were aged > 85 years, and three had concurrent diabetes mellitus, peripheral vascular disease, and ischemic heart disease. The survival rate in the UBF group correlated with the duration of dialysis in the three patients for whom the UBF was the sole AVF, with one patient achieving a remarkably prolonged period of > 10 years. No incidences of ischemia, hand edema, or ulnar nerve lesions were noted. While the difficulties experienced in achieving functional UBFs for HD are highlighted in this long-term perspective, its safety and durability make it a viable option in managing an increasingly comorbid patient population.