2013 Volume 22 Issue 1 Pages 1-6
According to clinical guidelines, arteriovenous fistula (AVF) by basilic vein transposition (BVT) might be considered if radial-cephalic and brachial-cephalic AVF fail. We report initial experience and early outcome of AVF by one-stage BVT. Twenty-seven consecutive patients (male : female=8:19, age 46–91 years, mean 72 years) who underwent brachial-basilic vein AVF by BVT in our institute were enrolled retrospectively in this study. The basilic vein in the upper arm level was evaluated by preoperative venography in all patients. Surgery was performed under general anesthesia in 21 patients, intravenous anesthesia in 2, and under local anesthesia in 4. Basilic vein at the upper arm was dissected as long as possible initially, then it was transposed at the anterior side of the upper arm, and finally anastomosed to the brachial artery in end-to side fashion. Graft flow was measured by the transit time method just after anastomosis, the result was 94–785 ml/min, mean flow: 313.2 ml/min. Postoperative clinical course was generally uneventful, but one patient died due to respiratory failure prior to use of this vascular access. The BVT was immature in one patient and iatrogenic BVT injury occurred in one patient. Therefore, 24 BVT (88.9%) were successfully used for hemodialysis at 9–18 days, mean 13.3 days after surgery. Graft failure due to thrombosis in the early phase occurred in two patients, one was in the brachial artery 37 days after surgery, the other was severe stenosis of the transposed basilic vein 141 days after surgery that was finally improved by surgical thrombectomy and percutaneous transluminal angioplasty (PTA). Dialysis-associated steal syndrome which was successfully revised by surgical ligation to reduce blood flow of transposed basilic vein, was indicated in one patient about 4 months after creation of BVT. Primary graft patency at one-year was 70.0%, and assisted primary patency was 85.0%. These results suggested that brachial-basilic vein AVF by one-stage BVT could be a reliable option and an alternative of forearm arteriovenos grafts (AVG) and failed or infected AVF, with less complications than high flow AVF and AVG. Mandatory care is necessary in high-risk patients to improve long-term outcome.
