Relationship of preoperative venous and arterial imaging findings to outcomes of brachio-basilic transposition fistulae for hemodialysis: a prospective clinical study.

PURPOSE: To evaluate the maturation and patency of transposed brachio-basilic fistulae that had been chosen based on the results of preoperative imaging techniques.

METHODS: Among 215 patients admitted to our clinic requiring arteriovenous fistulae between May 2004 and September 2005, 59 were scheduled for a transposed brachio-basilic fistula procedure. The relationship between demographic data, laboratory values, invasive and noninvasive imaging studies with patency and maturation time of the fistulae were evaluated by univariate analyses.

RESULTS: Primary and secondary patency rates were 82% and 97% at 6 months 72% and 92% at one year respectively. The only parameter found to affect maturation time was basilic vein diameter. The maturation time was 59.3+/-22.3 days (range 32-92 days) for veins less than 3mm in diameter and 24.7+/-4.4 days (range, 21 to 34 days) for those with larger diameters. The number of previously failed fistulae correlated with a decrease in primary patency time. The primary patency rate at 1 year was 58.9% for patients whose preoperative arterial flow rate was below 70cm/sec, while it was 93.3% when the flow was greater.

CONCLUSION: We believe that this type of fistula should be the first option in patients in whom the cephalic vein is inappropriate for a vascular access. Preoperative evaluation of the arterial system as well as a history of previous access failure may be considered predictive parameters for the patency of the fistulae.