Abstract
Superficialized upper arm basilic vein fistulae, looped E-PTEE graft fistulae, running off an upper arm basilic vein, on the forearm and straight-shaped E-PTFE graft fistulae on the upper arm were created for hemodialysis patients with forearm access failure. The effective use of an upper arm basilic vein was investigated by comparing these 3 procedures. The acturial patent rates of the superficialized upper arm basillc vein fistulae (18 cases) were: 1yr, 59.7%; 2yr, 45.7%; 3yr, 45.7%; and the cause of access failure was stenosis of the superficialized basilic veins due to intimal proliferation and thickening. The acturial patent rates of the looped E-PTFE graft fistulae (36 cases), including successful revisions, were: 1yr, 77.0%; 2yr, 63.1%; 3yr, 45.4%; and those of the straight-shaped E-PTFE graft fistulae (15 cases) were: 1yr, 86.2%, 2yr, 50.3%; 3yr, 43.1%. The causes of graft fistula failure were clotting (80%) and infection (20%). The acturial patent rate of the graft fistulae without revisions was calculated as 42.5%, and there was no clinical superiority between the 2 types of graft fistulae. The superficialized upper arm basilic vein fistulae are undesirable because of the low patent rate and difficult revisions.
In conclusion, it is preferable that the distal upper arm basilic vein be used as a run-off vein for the graft fistulae, and that creation of a superficialized upper arm basilic vein fistula be avoided at first. Failed graft fistulae should, if possible, be salvaged by active revisions.
