Basilic Vein Transposition Research Articles

Outcomes of prosthetic upper arm arteriovenous graft vs brachiobasilic fistula for hemodialysis access

ObjectivePrimary arteriovenous access such as radiocephalic and brachiocephalic fistulas are initial choices for creating vascular access in dialysis patients. When neither of these choices is an option, upper arm arteriovenous graft or brachiobasilic transposition is recommended. Although primary fistula is better than prosthetic graft for suitable patients, there is little data to guide the best treatment strategy in the absence of suitable vein for primary access creation. This study identifies factors that influence patency rates and compares outcomes of patients treated with brachiobasilic fistula vs upper arm graft in patients who have failed forearm access or are not candidates for primary access. MethodsA prospectively maintained database of patients with dialysis-dependent renal failure from 2010 to 2022 was analyzed. Primary, primary assisted, and secondary patency rates were calculated. Incidence rates of complications and reinterventions were compared. ResultsThere were 148 patients with brachiobasilic fistulas and 157 patients with upper arm grafts. The graft group was older (70.1 ± 14.7 vs 62.5 ± 14.6 years; P = .003) and had a higher incidence of pacemakers (11.9% vs 4.1%; P = .005). Brachiobasilic fistulas had higher 6-month (77.0% vs 64.3%; P = .02) and 1-year (68.2% vs 55.4%; P = .03) primary-assisted patency. Secondary patency rates were better for upper arm grafts at 1-year (82.2% vs 72.3%; P = .05). Access complications of non-maturation and aneurysm were higher in basilic vein transposition (21.6% vs 1.3%; P < .0001; 15.5% vs 6.4%; P = .017). Grafts had higher rates of occlusion (58.0% vs 25.7%; P < .0001). In terms of interventions, upper arm grafts had higher rates of thrombectomy (50.3% vs 18.9%; P < .0001), but there was no difference seen in angioplasty, stent, surgical revision, or steal procedures. Basilic vein transpositions had longer time to cannulation (104.6 ± 81.1 vs 32.5 ± 22.4 days; P < .0001), longer total catheter days (251.1 ± 181.7 vs 72.9 ± 56.3 days; P < .0001), and higher number of procedures to aid maturity (0.7 ± 0.7 vs 0.1 ± 0.3; P < .0001). ConclusionsIn this retrospective analysis, when forearm access or primary arteriovenous access is not an option, basilic vein transposition and upper arm grafts have fairly equivalent primary patency. Primary assisted patency is slightly better in basilic vein fistulas, but secondary patency is better in upper arm grafts at 1 year. Basilic fistulas also had longer time to cannulation, longer total catheter days, and more procedures to aid maturity.

Risk factors for thrombosis in dialysis patients: A comprehensive systematic review and meta-analysis

AimTo identify the factors associated with thrombosis in dialysis patients. BackgroundThrombosis is a leading cause of vascular access failure in dialysis patients. Numerous risk factors contribute to thrombosis in this population. MethodsA systematic search was conducted across international databases using standardized keywords. The quality of the selected studies was assessed using the STROBE and CONSORT checklists. The findings were summarized in a Garrard table. Meta-analysis was performed using CMA software. The study adhered to the guidelines outlined in the PRISMA statement. ResultsA total of 180 articles were reviewed. The odds ratio for thrombosis in patients with arteriovenous grafts compared to arteriovenous fistulas was 10.93 (95 % CI: 9.35-12.78), demonstrating statistical significance (P = 0.001). Similarly, hemodialysis patients had an odds ratio of thrombosis 3.60 times higher than non-hemodialysis patients (95 % CI: 3.54-4.19), with statistical significance (P = 0.001). Patients undergoing single-stage basilic vein transposition had a 1.89 times higher risk of thrombosis compared to those undergoing two-stage transposition (95 % CI: 1.04-3.46), also demonstrating statistical significance (P = 0.038). ConclusionsThrombosis in patients with end-stage renal disease undergoing dialysis was significantly associated with various factors, including graft access, single-stage basilic vein transposition, and hemodialysis. Additional contributing factors to thrombosis included diabetes, elevated homocysteine levels, female gender, age over 50, access location, and low access blood flow velocity. The analysis revealed a higher incidence of thrombosis in end-stage renal disease patients undergoing hemodialysis compared to those not undergoing dialysis, as well as in patients with arteriovenous grafts compared to those with arteriovenous fistulas. These findings underscore the importance of recognizing and managing these risk factors to prevent thrombotic events and enhance patient care within the dialysis setting.

Abstract 3092: Smooth Muscle Cell Tgf-β Receptor Knockout Improves Arteriovenous Fistula Maturation Via Attenuation Of Autophagy

Objectives: Arteriovenous fistulae (AVF) are the preferred vascular access for patients with end-stage renal disease (ESRD) but have high rates of primary failure. Models of AVF using mice with chronic kidney disease (CKD) show diminished maturation and increased failure compared to AVF using wild type mice. Since mice with CKD show increased TGF-β1 expression and activity in the AVF model, and TGF-β1 signaling can alter autophagy, we hypothesized that CKD increases autophagy during AVF maturation, whereas inhibition of the smooth muscle cell (SMC) TGF-β receptor would attenuate autophagy and promote AVF maturation. Methods: An aortocaval fistula or sham procedure was created in mice that had CKD induced by 5/6 nephrectomy (5/6 Nx) or sham nephrectomy (0/6 Nx). Myh11-CreER T2 ; Tgfbr1 fl/fl ; Tgfbr2 fl/fl ; mT/mG mice (TGFβRI II-KO) and control C57BL/6J mice were used. The diameter of the IVC was determined using ultrasound at days 0, 7, 14, and 21. AVF were harvested at day 7 or 21 for histology and immunoreactivity. Deidentified human AVF and control vein specimens were collected for analysis from second stage basilic vein transpositions. Results: In C57BL/6J mice, AVF had significantly decreased diameter (p=0.0051), increased wall thickness (p=0.0002), as well as increased immunoreactivity of collagen-1 (p=0.0163), collagen-3 (p=0.0029), TGF-β1 (p=0.0184) and fibronectin (p=0.00321) in mice with CKD compared to control mice (n=6). SMC showed increased markers of autophagy (LC3B and P62) in mice with CKD compared to control mice (LC3B, p&lt;0.0001; P62, p=0.006; n=6); similarly, autophagy makers were increased in human AVF compared with the control veins (LC3B, p=0.0023; P62, p=0.006; n=6). In SMC-TGFβR II-KO mice, AVF had significantly decreased wall thickness (p&lt;0.0001), increased diameter (p=0.0258), and decreased expression of autophagy markers (LC3B, p=0.0014; P62, p=0.0046; n=6). Conclusion: CKD increases neointimal hyperplasia that is associated with increased autophagy during AVF failure, and diminished TGF-β signaling reduces autophagy and wall thickness as well as increases AVF diameter. Suppression of SMC autophagy might be a novel therapeutic approach to improve AFV function.

Ultrasound-guided Supraclavicular Brachial Plexus Block with Ropivacaine in Basilic Vein Transposition Surgery for Chronic Renal Failure Patients: An Interventional Study

Introduction: Basilic Vein Transposition surgery (BVT) is preferred under ultrasound-guided supraclavicular brachial plexus block, which provides excellent and safe anaesthesia in Chronic Renal Failure (CRF) patients. Ropivacaine, with a shorter elimination half-life than bupivacaine and better pharmacokinetics, is a safer option as a local anaesthetic agent in CRF. Aim: To assess the onset and duration of sensory and motor blockade with 20 mL of 0.5% ropivacaine in ultrasound-guided supraclavicular block and the need for additional local infiltration at the surgical site for BVT. Materials and Methods: In present interventional study conducted in the Department of Anaesthesiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, 25 American Society of Anaesthesiologists (ASA) III/IV CRF patients, aged 18-80 years, who underwent BVT surgery, were included from December 2021 to November 2022. A 20 mL dose of 0.5% ropivacaine was administered to these patients via ultrasound-guided supraclavicular block. The surgeon performed local infiltration with 10 mL of lignocaine at the T2 dermatomal area in all patients. Descriptive statistics were calculated for age, weight, ASA status, onset and duration of sensory and motor blockade, and the need for additional local infiltration. Results: The mean age and mean weight of the patients were 52 years and 57.68 kg, respectively. Total 17 were male and eight were female, while 23 were ASA III and two were ASA IV. After administering the supraclavicular block, the mean onset of sensory and motor blockade was 9±2.3629 and 13.16±2.6721 minutes, respectively. The mean duration of sensory and motor blockade was 612.8±132.815 and 522.8±121.124 minutes, respectively. All patients required local site infiltration (10 mL of 1% lignocaine-Adrenaline) as the T2 dermatome is usually spared by the supraclavicular block. Three patients required additional local anaesthetic infiltration. Conclusion: Minimising the concentration and volume of local anaesthetic drugs without compromising efficacy is challenging, particularly in BVT, where the incision is extensive and performed under supraclavicular BPB in high-risk CRF patients. The anaesthesia practice of using a low volume of 0.5% ropivacaine in BPB under ultrasound guidance, along with local anaesthetic infiltration with 1% lignocaine with adrenaline at the T2 dermatome, can serve this purpose without any complications.

Superficialization of the Basilic Vein in Brachiobasilic Arteriovenous Fistula: An Alternative Vascular Access for Hemodialysis- A Single Center Experience

Introduction: The use of basilic vein to create brachiobasilic arteriovenous fistula (BBAVF) is the vascular access option of choice for hemodialysis when cephalic veins are not available. To create BBAVF, the basilic vein should be superficialized and lateralized. The study aims to highlight the outcome and morbidity of BBAVF at the tertiary referral center and aims to improve the results of the procedure in patients with chronic renal failure.Materials and Methods: This is prospective, descriptive study conducted at College of Medical Sciences Teaching Hospital from January 2019 to December 2022.The demographic data, morbidities, results were analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (SPSS).Results: We evaluated outcome of total forty patients who underwent BBAVF with transposition of basilic vein. The mean age of patients was 61 ± 10.85 years and male:female ratio was 2.07:1. The mean size of basilic vein was 3.05 ± 0.84mm and brachial artery was 4.11 ± 0.99mm. The most common co-morbidities in this study was Diabetes Mellitus and hypertension both was present in 52.5% of patients, only hypertension in 27.5%, only Diabetes Mellitus in 5%, HTN with PVD in 2.5% and HTN, Diabetes Mellitus with PVD in 2.5% of patients. The postoperative complications were bleeding in 25% (10), infection 10% (4), primary failure 7.5% (3), pseudoaneurysm 5% (2), and oedema 7.5% (3).Total 82.5% (33) of cases were able to start dialysis in 45 days. The failure rate was 12.5% (5) due to thrombosis and pseudoaneurysm.Conclusion: BBAVF is a suitable option for vascular access in patients with failed previous AVF or patients with small cephalic vein. Relocation of basilic vein for AVF is feasible, safe and with good patency and complication rates are acceptable.

Single stage versus two stage basilic vein transposition for hemodialysis access: A retrospective observational study.

The basilic vein transposition is a brachio basilic arteriovenous fistula (AVF) made after the mobilization and transferring of basilic vein to the ventral aspect of arm inside a subcutaneous pocket by direct dissection. The procedure can be performed either in single stage or two stages. This study compares the clinical efficacy and long term utility of single-stage and two-stage basilic vein transposition among patients of renal failure and to evaluate failure rate, primary patency rates, and postoperative complications. Patients who underwent basilic vein transposition at Sindh Institute of Urology and Transplantation, Karachi from January 2021 to December 2021 were retrospectively reviewed. Patients were divided into two groups according to single stage or two-stage procedure. After the surgical procedure, assessment of fistula maturation and surveillance were undertaken using ultrasound and physical examination. Patients were requested to visit the out-patient clinic for assessment of fistula patency and post-operative complications at regular intervals of 3, 6, and 12 months respectively. During the 12 months' interval, 82 (39.04%) basilic vein transpositions were performed in single-stage and 128 (60.95%) were two-staged transposition. In our analysis we have found that as compared to single stage, two-stage basilic vein transpositions showed significantly better primary patency rates (76.82% vs 96%; p-value 0.000) and required less interventions for maintaining fistula patency. More post-operative sequelae were noted in the single stage version of the procedure as compared to the two stage procedure. Two stage procedure of basilic vein transposition is found to have better patency rate and lesser post-surgical complications. However, a matched cohort prospective study is still needed to further strengthen the conclusion.

Comparative study between 1-year patency of brachiobasilic arteriovenous fistula versus brachial to basilic forearm loop graft in patients with end-stage renal disease

Background The most preferred method of vascular access is the autogenous arteriovenous fistula (AVF). When ready for dialysis, autogenous AVF outperforms arteriovenous grafts (AVG) in terms of patency and survival. An alternate method of vascular access for such individuals is the transposed AVF or AVG. Aim The goal of this trial is to evaluate and contrast the results of those who were treated with a brachiobasilic (BB) AVF to those who were treated with a polytetrafluoroethylene brachial to basilic forearm loop graft. Primary endpoints Assisted primary patency, primary patency also secondary patency. Secondary endpoints: postoperative complications (wound infection, bleeding, steal syndrome, and procedure-related mortality), functional maturity. Patients and methods This is a prospective cohort observational trial performed at the Vascular Surgery Department, Faculty of Medicine, Ain Shams University. Data about patients who had forearm loop grafts or BB AVFs during the period from January 2021 to January 2022 were collected according to the study inclusion criteria. There was a total of 50 individuals included (25 patients in each group). The first group included cases who had BB AVF with basilic vein transposition (BB tAVF) whereas the second group included patients who had brachial-basilic forearm loop graft (BB AVG). Results Regarding age and sex distribution or risks of cardiovascular events, there was not a statistically significant distinction among the two study groups. The fistula group required statistically significant longer time to achieve functional maturity mean±SD (BB tAVF=9.64±2.29 vs .BB AVG=6.6±2 assisted and secondary patencies at 3, 6, 12, and 18 months). No statistically significant variation existed among groups regarding postoperative bleeding, infection, and procedure-related mortality. Conclusion Both BB AVF and polytetrafluoroethylene brachial to basilic forearm loop graft can be considered as viable options for vascular access in this patient population. The choice of procedure may depend on individual patient factors, possible risks of prolonged central venous catheter (CVC) use, as well as the risks of infection and thrombosis, which should be carefully evaluated.

A Randomized Comparative Evaluation Of Effects Of Dexmedetomidine As An Adjuvant With Bupivacainein Supraclavicular Block In Crf Patients Undergoing Basilic Vein Transposition Surgery

Aim: To compare analysis of bupivacaine in supraclavicular block with dexmedetomidine bupivacaine in supraclavicular block in chronic renal failure patients undergoing basilica vein transposition surgery. Methodology: Double-blind randomised control trial. Department of Anaesthesia, Sindh Institute of Urology and Transplantation, Karachi, from September 1st, 2021, to February 28th, 2022 Seventy chronic renal failure patients undergoing elective basilic vein transposition surgery were enrolled. Patients were divided into two groups, in which 35 patients in group A received bupivacaine (0.25%) in 28mL plus dexmedetomidine (1ug/kg) diluted to 2 mL, and 35 patients in group B were injected with bupivacaine (0.25%) in 28 mL plus 2mL of normal saline. Results: The mean time of onset of sensory blockade was comparatively higher in group B as compared to group A. Similarly, the onset of motor block time was also higher in group B as compared to group A, and the duration of motor block did not show any significant results between groups, and the duration of motor block was not statistically significant between groups [p = 0.404]. Conclusion: The combination of bupivacaine and dexmedetomidine appeared to be useful for onset time and prolongs the duration of analgesia in supraclavicular brachial plexus block. Keywords: Chronic kidney disease, Dexmedetomidine, Supraclavicular brachial plexus block

Painless ulceration due to digital hypoperfusion ischaemic syndrome: case report and literature review

Digital hypoperfusion ischaemic syndrome (DHIS), also known as steal syndrome, is a well recognised serious complication of haemodialysis (HD) access creation. The clinical presentation varies from cyanosis to tissue loss due to necrosis or gangrene. In this article, we present a case of painless digital ulceration due to DHIS and provide a review of the literature. A 40-year-old-female presented with multiple painless digital ulcerations of the left hand. Her medical profile included atherosclerotic disease, hypertension, hyperparathyroidism and type I diabetes causing retinopathy, peripheral neuropathy, gastroparesis and end-stage renal disease (ESRD). Her ESRD required HD with the construction of a left-arm basilic vein transposition arteriovenous fistula (AVF). A year later, she developed intermittent, painless ulcerations of the left hand. A Doppler ultrasound confirmed the diagnosis of DHIS. The patient was treated with AVF ligation surgery. At six months postoperatively, she had near complete re-epithelialisation of her ulcers. This case is unique in that the patient did not have preceding pain, likely due to her underlying diabetic neuropathy. While DHIS in haemodialysis patients with AVF is well documented in literature, digital ulceration in this context is an advanced form of this condition. Early recognition of digital ulceration as a complication of DHIS may enable early intervention and prevent permanent damage.

An Observational Study on Transposed Brachial Artery ‒ Basilic Vein AV Fistula in Vascular Access for Hemodialysis

Background: Dialysis access in patients of chronic kidney disease (CKD) on long-term hemodialysis is a problem area. Patients with poor caliber veins distally on initial evaluation or with multiple fistula failures, basilic vein transposition is a good alternative. We present our experience with basilic vein transposition at our center. Methods: This study was a single-center observational study. A retrospective review of prospectively collected data from December 2013 to June 2019 was done. Qualitative variables were expressed as frequencies/percentages and compared between groups using the Chi-square test. Quantitative variables were expressed as mean ± standard deviation and compared between groups using unpaired t-test between groups and paired t-test within groups across follow-ups. Multiple linear regression analysis using a stepwise model selection tool was used to assess factors affecting the first cannulation. The best model was arrived in four steps where explanatory power (R 2) increased from 66.6% to 79.3% (P &lt; 0.001). Results: One hundred and eighty-eight patients formed a part of the study. One hundred and sixty-four patients underwent single stage, whereas 24 underwent two-stage transposition. Ninety-four each were male and female. The mean age was 51.38 ± 14.74 years. About 96.27% of fistulas underwent successful cannulation. The overall mean maturation time was 44.46 ± 7.21 days. It was 42.28 ± 3.71 for single and 60.27 ± 6.66 days for two-stage procedures. Primary patency at 6 months and 1 year were 92.82% and 85.67%, whereas primary-assisted patency rates were 94.6% and 91%. The secondary patency rate at 1 year was 60.77%. Salvage procedures included thrombolysis in 2, thrombectomy in 18, and thrombectomy with venoplasty in four cases. There were 28 failures. Fistula thrombosis was the most common cause. Complications included transient arm edema in 36.7%, late thrombosis in 7.7%, wound infection in 4.4%, and lymphorrhea in 6.9% of patients. Conclusion: The smallest basilic vein diameter for successful transposition is 2.5 mm. Factors used to predict successful maturation are initial vein diameter ≥2.5 mm, preoperative Peak systolic velocity (PSV) in brachial artery &gt;70 cm/s, fistula flow rate of &gt;400 ml/min at 6 weeks, and fistula diameter &gt;4.5 mm at 06 weeks.

Fourteen-Year Patency of an Anterior Tibial Artery-Saphenous Vein Fistula in an Ambulatory Patient

Ankle arteriovenous fistulas are the rarest vascular access type among lower extremity fistulas for hemodialysis patients with end-stage renal disease. Here, we present a case of a tibial-saphenous fistula that remained open for a long time despite a recurrent anastomotic aneurysm. Case Presentation. A 43-year-old female patient who had been undergoing hemodialysis via a right femoral tunnel catheter for six months was referred for recurrent catheter infection and a 4 cm pulsatile mass in the anterior aspect of the ankle. While she had been undergoing hemodialysis through a right tibial-saphenous fistula for fourteen years, hemodialysis continued after the fistula's closure due to total occlusion of the great saphenous vein through the tunneled catheter. After balloon angioplasty to the right subclavian vein, we performed right upper extremity basilic vein transposition. Later, after starting adequate dialysis from the basilic vein fistula and removing the femoral catheter, we performed a resection of the anastomotic aneurysm in the right ankle and repaired the anterior tibial artery. Because this is the only ambulatory patient and the one with the longest patency of ankle arteriovenous fistulas in the literature and the only case in which the anterior tibial artery was used, the case is presented and discussed in light of the literature. Despite many complications and low patency rates reported in the literature, ankle vessels should be considered for autogenous vascular access in selected patients.

The outcomes of a novel two-stage proximal brachial artery to proximal basilic/brachial vein arteriovenous graft extension for dialysis access.

We describe a technique to mature a basilic/brachial vein in the mid-arm in preparation for a second stage loop proximal brachial artery to basilic/brachial vein arteriovenous graft (BBAVG). This can occur after a failed basilic/brachial vein transposition or a lack of adequate veins in the distal arm. This allows a mature vein to be used in an end-to-end configuration as an outflow to a BBAVG while preserving proximal vessels for the future. This single-center retrospective study was performed from 2015 to 2021, including 104 AVG patients divided into three groups: (1) Patients who failed a basilic vein transposition and had an enlarged vein suitable for an AVG outflow; (2) Patients who had a small caliber basilic/brachial vein after the transposition, requiring a mid-arm brachial artery to brachial/basilic arteriovenous fistula (AVF) creation with a subsequent AVG extension; (3) and lastly, patients who had no distal arm veins available and required a primary brachial artery to basilic/brachial AVF with AVG extension. A survival analysis was performed looking at time to loss of primary and secondary patency, calculated with Kaplan-Meier estimates and Cox regression models adjusted for covariates. The median follow-up time was 11 months (IQ = 11-30 months). The survival analysis showed 28% lost primary patency at a median time of 9 months, and 14% lost secondary patency at a median time of 61 months. Overall secondary patency of the vascular access measured at 12 months was 85.6%. Loss of primary (p = 0.008) and secondary patency (p = 0.017), as well as patency during the first 12 months (p = 0.036), were all significantly associated with increased age when adjusting for covariates. Our results suggest that the graft extension technique using a mature vein from a previous fistula can result in reliable and durable access. This is important for patients with limited access for hemodialysis, as the axillary vein is preserved for future use if needed.

Transposition of basilic vein for vascular access for haemodialysis: An experience of a tertiary care hospital.

Basilic vein transposition (BVT) is the preferred permanent haemodialysis access due to better patency and lower infection rates compared to synthetic grafts. The outcomes of BVT cases, performed at Shifa International Hospital, Islamabad, from March 2006 to June 2018, were ambispectively investigated. The primary patency of the fistula was assessed immediately after surgery, at 24 hours, at 7-14 days, at 6-8 weeks and then at 3-6 months. A total of 160 patients were included in the study, out of which 83 (51.87%) were males while 77 (48.12%) were females. Of the total 160 patients, 119 (74.4%) underwent one stage BVT, while 41 (25.6%) underwent two stage BVT. One hundred and thirty-five (84.4%) procedures were successful and survived while in 25 (15.6%) cases it failed. Mean basilic vein diameter was 2.712±0.772 mm. Overall, 10(6.3%) patients had bleeding, 15(9.4%) fistulae thrombosed, 6(3.8%) had steal syndrome and only 1 (0.6%) patient developed pseudo aneurysm. We conclude that BVT is a feasible technique with very good patency rate especially for those patients who have multiple forearm AVF surgeries.

TP10.2.8Adaptation in providing renal access surgery service in response to covid-19 pandemic- a single centre experience

AimEvaluate impact of Covid-19 pandemic on renal access surgery and changes in practice towards counteracting limitations to provide safe and effective peritoneal and haemodialysis.MethodsRetrospective review of procedures for dialysis in ESRD patients from institutional databases in a single centre was carried out. Patients undergoing peritoneal catheter insertions (PD) or AV fistula formation (HD) between March 2020 and October 2020 were compared with similar period in 2019. Demographic, procedure and postoperative outcome data was collected.ResultsBetween March and October 2019, 143 combined PD and HD procedures were performed compared to 98 in the same time period in 2020. The mean age of patients was 65 ± 15 years and 62 ± 12 years, respectively. In 2020, 26 patients had PD catheter insertion and 22 patients in 2019. 18% of these were performed laparoscopically in 2019 compared to 33% in 2020. The same day discharge rate increased to 34% from 22%.Patients having complex fistula procedures including basilic vein transpositions and grafts requiring overnight stay dropped from 83% patients (n = 23) to 71% (n = 7) in 2020.In 2019, 80% (n = 49) patients had radio-cephalic fistula performed as same day procedure increasing to 98% (n = 22) in 2020.Day-surgery unit utilisation increased from 55% to 71%. Same day discharge rate increased from 53% to 66%. There were no readmissions.ConclusionsAdaptations in terms of increased support for same day surgery even for complex renal access procedures has improved service. A greater proportion of renal access service can be same day procedures avoiding inpatient stay.

Elevation Transposition Method for Superficialization of the Basilic Vein Achieves Better Patency Rate than Tunnel Transposition

To compare the tunnel transposition and elevation transposition methods used for superficialization of the basilic vein in terms of complication and patency rates. This retrospective study included patients who underwent 2-stage basilic vein transposition between August 2016 and December 2019. Patients were categorized into brachial-basilic fistula tunnel transposition (n=32) and elevation transposition (n=21) groups using medical records. Primary patency was defined as a conduit that remains patent without any re-intervention to maintain patency. Primary assisted patency was defined as a conduit that has undergone intervention to maintain patency but has never been thrombosed. The distribution of baseline characteristics was similar between the 2 groups. Coronary artery disease was the only variable that was significantly different between the tunnel transposition and elevation transposition groups (31.1% vs. 4.8%, P=0.035). The tunnel transposition group had a greater amount of blood loss (P < 0.001) and a longer period of hospitalization (P=0.002) than the elevation transposition group. The rates of suture repair to stop bleeding from the conduit was significantly different between the tunnel transposition and elevation transposition groups (31.8% vs. 4.8%, P=0.035), whereas those of other complications were not significantly different. The elevation transposition group had a significantly higher primary patency rate than the tunneled transposition group (P=0.033); however, primary assisted patency was achieved in all patients (100%) in both groups. Elevation transposition might be a more reliable method than tunnel transposition for superficialization of a basilic venous fistula.

Use of forearm basilic vein as an option of upper limb vascular access for haemodialysis

Abstract Authors : Mohamed ashraf elsayed elshazli, Samer abdelhamid regal MD , Hossam Mohamed Mustafa MD, Amr Mohamed Mustafa MD . Background: in our stuy , we aimed to evaluate the outcome of forearm basilc vein transposition and anastomosis to either radial or brachial areteries to create arteriovenous fistula for haemodialysis . Patient and Methods : This is an observational prospective study conducted from august 2019 to December 2020 at the Department of Vascular Surgery, Mansoura University hospital . 25 patients were selected for forearm basilic vein transposition (FBVT ) . 18 cases underwemt BB loop AVF and 7 cases underwent radiobasilic AVF . procedure was done under combined supraclavicular and local xylocaine 1% anaethesia . Basilic vein was harvested using multiple incisions then elevated and anastmosed to either radial artery in 7 cases or tunneled as aloop and anastomsed to brachial artery in 18 cases . Results: The mean age of patients who received an AVF was 56.96±9.61 years, with a range of 35 to 70 years, and included 19 men (76%) and 6 women (24%).18 cases underwemt BB looped AVF and 7 cases underwent radiobasilic AVF . patients were followed up for 1 year. 1ry patency rates at 3,6,12 months were 84% ,83.3%,82.6%. Conclusion: Radiobasilic or forearm brachiobasilic looped AVF can be used as an alternative option in case of cephalic vein inadequancy or if it was previously used for haemdialysis.

Hybrid and Percutaneous Salvage of a Thrombosed Native Arteriovenous Fistula

Context: Outcomes of salvage procedures for thrombosed native arteriovenous fistulas (AVFs) are studied. Aims: The aim of this study is to assess the short- to mid-term results of percutaneous and hybrid approaches used for salvage of thrombosed native AVF. Settings and Design: This study design was a single-center, descriptive, prospective study. Materials and Methods: All patients undergoing hybrid or percutaneous salvage procedure between July 2018 and September 2019 were included in the study. Patient demographics, clinical, and operative details and follow-up data at 1 year were collected from a prospectively maintained database and subjected to statistical analysis. Salvage procedure selection and techniques were studied. Statistical Analysis: Chi-square test and Fisher's exact test.P&lt; 0.05 was considered statistically significant. Results: Out of 135 patients undergoing salvage procedure during the study period, 85 patients were included in the study based on inclusion and exclusion criteria. The age of the study population ranged from 18 to 75 years with a mean of 53.33. 75.3% (n = 64) were males. Seventy-seven (90.58%) patients were hypertensive, 45 (52.94%) were diabetic, and 22 (25.88%) had coronary artery disease. The mean time to procedure from the failure of AVF was 8.22 days. The most common type of AVF was brachiocephalic (45.88% [n = 39]), followed by radiocephalic (36.47% [n = 31]) and basilic vein transposition (BVT) (17.64% [n = 15]). Stenotic sites were juxta anastomotic in 42 (49.41%), cephalic arch or axillary swing segment (for BVT) in 28 (32.94%), and intervening segment in 54 (63.52%). Sixty patients underwent hybrid salvage and 25 underwent percutaneous salvage procedure. Technical success was 88.23% on table and 83.53% at 24 h. Primary, primary assisted, and secondary patency was 67.86%, 82.14%, and 89.29% at 6 months and 50%, 68.75%, and 83.33% at 12 months. Anastomotic thrombosis was associated with significantly high technical failure (35.7% vs. 12.67%,P= 0.049). Conclusions: A combination of open and endovascular procedures to salvage thrombosed native AVF's is feasible and is associated with good short- and mid-term patency. A thrombosed anastomosis in a failed AVF decreases the success rate of salvage procedures.

Stretching the boundaries: suitability of an arteriovenous fistula in elderly patients on hemodialysis-a northern India experience.

Considering various factors, such as multiple co-morbidities, unsuitable vessels for access creation, non-maturation, vascular calcifications, the outcome of arteriovenous fistula (AVF) in the elderly population, may not be similar to the younger people. Our study aims to analyze the outcomes of AVF in elderly patients (> 65year). It was a prospective observational study. Patients of more than 65years of age in whom AVF was created from January 2012 to December 2015 were included in the study. These patients were followed up for 4years. The primary endpoint of our study was to assess primary and secondary patency rates. A total of 450AVFs were included in the study. The mean age was 68.5years. The most common site of AVF was radiocephalic (RCAVF) in 70% (n = 315), brachiocephalic (BCAVF) in 24% (n = 108) and basilic vein transposition (BVT) in 6% (n = 27). At 48months, the primary patency rate of RCAVF, BCAVF, and BVT was 55%, 61.6%, and 60.4%, respectively. The commonest cause of access failure was thrombosis followed by non-maturation. AVF remains the preferred vascular access for hemodialysis even in the elderly population. Failure to mature and thrombosis continue to be a concern with AVF. Location of the AV access does not seem to impact the long-term patency.

Primary patency of native arteriovenous fistula in elderly at Abdul Wahab Sjahranie Hospital, Samarinda, Indonesia

Introduction. Arteriovenous fistula (AVF) is preferred to be selected by the patient and clinician due to long term survival and fewer complications than other vascular access. Radiocephalic (RC) fistula is the first choice for dialysis access and should be performed in elderly renal failure patients. Several authors have advocated that the brachiocephalic (BC) fistula should be considered the surgeons' first option. We aim to analyze the primary patency of RC and BC AVF in the elderly. Method. This prospective cohort study was conducted from June 2018 to March 2020, which included 58 elderly patients who underwent surgery to create AVF. Demographic data were collected from medical records. Meanwhile, information about patient’s primary patency of RC and BC AVF were followed up to first access dysfunction or any intervention by phone. The survival data were analyzed using the Kaplan-Meier method Result. There were 58 elderly patients divided into 51 (87.9 %) patients with RC, 4 (6.9%) patients with BC, and 3 (5.2%) patients with Basilic Vein Transposition (BVT). The survival rate of RC was 70.5 % after six months and 29.4 % after 12 months. Meanwhile, 50% of BC patients survived in the first six months, and 25% survive for a year. On the other hand, 1 of 3 patients died in the BVT group in the first month after access placement due to hemodialysis complication, and the remaining two BVT patients survived in three months. Conclusion. RC has a patency rate of 70.5% in six months and 29.4% in a year. Choosing the right type and site of the anastomosis is essential as life expectancy increases in the elderly to preserve the veins for future access site.

Late Basilic Vein Superficialization Combined with Revision Using Distal Inflow (RUDI) Operation to Treat a Symptomatic High Flow Fistula

BackgroundVascular access (VA)-related high flows (HF) are common with brachial artery based fistulas. Flow-reduction procedures are indicated in symptomatic patients or asymptomatic ones with flows >2 L/min. However concomitant issues increase their complexity. We describe a case of a patient suffering congestive heart failure as a result of HF brachial-basilic fistula >3 L/min. A simultaneous late basilic vein transposition and revision using distal inflow (RUDI) was performed. MethodsA large diameter untransposed arterialized basilic vein was carefully and completely mobilized up to the proximal upper arm. After harvesting an autologous great saphenous vein (GSV) segment, a new inflow anastomosis was performed in the proximal ulnar artery. At the final stage, and after tunneling the mobilizing basilic vein in a subcutaneous semicircular configuration, an end-to-end anastomosis joining the two stumps (basilic vein outflow portion and GSV inflow arterial portion) was performed. A decision-making process in order to reach this complex option is discussed. Results Access flow and cardiac output were greatly attenuated following our approach. After a mean follow-up of 9 months no VA complications were observed, with flow still detected below 2 L/min. All cardiac symptoms and ultrasound investigations improved. ConclusionMultiple VA issues including HF pose a risk for abandonment and a challenge for the vascular surgeon. An effort toward increasing the “upper extremity life span” is advised.