Basilic vein transposition fistula: a good option for maintaining hemodialysis access site options?
OBJECTIVE
The primary use of autogenous arteriovenous access for chronic hemodialysis is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines. We review the outcomes of basilic vein transposition (BVT) to assess its value as a primary upper arm arteriovenous access option.


METHODS
A retrospective review of 56 patients undergoing BVT was performed. Thirty patients were men; average age was 56 years. Etiology of end-stage renal disease, complications, and time to maturation were tabulated. Primary and secondary patency rates were determined by using life table methods. Multivariate regression analysis was performed to assess risk factors for fistula failure.


RESULTS
Renal failure was associated with diabetes in 32 (57%) patients, and BVT was the primary access procedure in 22 (39%) patients. Perioperative complications occurred in 5 (9%) patients and included hematoma (n = 3), myocardial infarction (n = 1), and death (n = 1). The average time to maturation was 74 days (range, 12-265 days), and maturation failure occurred in 21 (38%) patients. Logistic regression analysis showed that age older than 60 years was associated with poorer maturation and patency rates. On an intent-to-treat basis, 1-year primary and secondary patencies were 35% and 47%, respectively, but only 18% and 28%, respectively, for age >60 years. Forty-two percent of failed BVT were subsequently replaced with a prosthetic graft by using the same upper arm vessels.


CONCLUSIONS
BVT frequently do not mature in patients older than 60 years, which compromises its utility as a primary access. However, fistulas that mature provide acceptable patency rates, and subsequent conversion to a prosthetic access is frequently possible. Selective use of BVT might improve the utilization of available access sites.
Rao
Rajeev K
RK
Division of Vascular Surgery, Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
Azin
G Darius
GD
Hood
Douglas B
DB
Rowe
Vincent L
VL
Kohl
Roy D
RD
Katz
Steven G
SG
Weaver
Fred A
FA
D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D015993:Life Tables; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation