Potential benefits of basilic vein preservation in upper-arm arteriovenous fistula creation: Implications for stenosis site alteration.

BACKGROUND

Cephalic arch stenosis (CAS) is the most common complication of upper-arm AVFs, with an incidence ranging from approximately 19% to 77%. In contrast, the incidence of CAS is much lower in forearm AVFs. This study aims to investigate whether the presence of additional outflow pathways, such as those seen in forearm AVFs, influence the location of stenosis in upper-arm AVFs.

METHOD: From January 2019 to December 2024, we retrospectively reviewed 96 patients with upper-arm AVFs who underwent PTA at our hospital. Patients were divided into two groups based on the outflow pattern: Group 1, with cephalic vein outflow only; and Group 2, with both cephalic and basilic vein outflow. Additionally, we retrospectively analyzed 137 patients who underwent creation of a new upper-arm AVF during the same period. These patients were similarly categorized into two groups according to the outflow pattern: Group 1, with cephalic vein outflow only; and Group 2, with both cephalic and basilic vein outflow.

RESULT: Among patients who underwent PTA, the incidence of CAS was significantly higher in Group 1 (54.7% vs 12.5%, p < 0.001). The incidence of distal cephalic vein stenosis was significantly higher in Group 2 (90.6% vs 43.8%, p < 0.001). For patients who underwent creation of a new upper-arm AVF, there was no significant difference in primary maturation rates between the two groups (77.9% vs 73.3%, p = 0.533), nor in secondary maturation rates (89.6% vs 95%, p = 0.347).

CONCLUSION

Preservation of the basilic vein in upper-arm AVFs may shift the site of stenosis from the cephalic arch to the distal cephalic vein. Distal cephalic vein stenosis is easier to treat with endovascular or surgical intervention, and it allows preservation of the axillary vein for future AV access creation. Moreover, preservation of the basilic vein did not negatively affect fistula maturation rates.