Vascular access outcomes using the transposed basilic vein arteriovenous fistula.
BACKGROUND
Although the transposed basilic vein arteriovenous fistula (TBAVF) is increasingly performed for hemodialysis vascular access in patients lacking adequate superficial veins, little is known about the long-term patency or risk factors for failure.


METHODS
A retrospective analysis was conducted for 99 patients who had a TBAVF created between April 1997 and October 2001. Primary outcomes were unassisted and assisted patency rates and primary failure rates.


RESULTS
This was the first access procedure in 46% of patients, mean age was 55 years, and 46% were men. Unassisted and assisted patency rates were 47% and 64% at 1 year and 41% and 58% at 2 years, respectively. Primary access failure occurred in 23% of cases. Unassisted access patency was significantly worse in patients with a previous access (relative risk [RR], 2.04; confidence interval [CI], 1.09 to 3.85; P = 0.03) or an ipsilateral central venous catheter (RR, 2.92; CI, 1.34 to 6.38; P < 0.01). Primary access failure was affected by older age (RR, 2.0; CI, 1.20 to 3.38; P < 0.01), obesity (RR, 7.1; CI, 1.65 to 30.1; P < 0.05), and a previous vascular access (RR, 6.4; CI, 1.49 to 27.6; P = 0.01). Steal syndrome requiring intervention occurred in 5% of cases.


CONCLUSIONS
In summary, the TBAVF provides a viable option for vascular access; however, certain patient characteristics seem to affect long-term patency and should be considered when exploring access options.
Segal
Jonathan H
JH
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109-0364, USA. jhsegal@umich.edu
Kayler
Liise K
LK
Henke
Peter
P
Merion
Robert M
RM
Leavey
Sean
S
Campbell
Darrell A
DA
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002408:Catheters, Indwelling; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000628:therapy; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome; D014654:Vascular Patency