title: Vascular access outcomes using the transposed basilic vein arteriovenous fistula.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109-0364, USA. jhsegal@umich.edu
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Segal
authors.forename: Liise K
authors.initials: LK
authors.lastname: Kayler
authors.forename: Peter
authors.initials: P
authors.lastname: Henke
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: Sean
authors.initials: S
authors.lastname: Leavey
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
mesh_terms: 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