Long-term outcomes of basilic vein transposition fistula for hemodialysis.

BACKGROUND

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.

PATIENTS AND

METHODS

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).

RESULTS

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.

CONCLUSION

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.