Two-stage brachiobasilic arteriovenous fistula for chronic haemodialysis access.
BACKGROUND
Many haemodialysis patients are unable to have or maintain distal upper limb arteriovenous (AV) fistulas because of inadequate veins or arteries and therefore require more proximal access. We have reviewed our experience with a two-stage brachiobasilic AV haemodialysis fistula fashioned in the arm.


METHODS
Ninety-one brachiobasilic AV fistulas were fashioned in 87 patients between August 1999 and October 2004. Four AV fistulas failed because of early thrombosis. The second stage 'superficialization' was carried out at a median (range) of 73 days (32-1827 days) after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the anteromedial aspect of the arm and transposing it beneath the skin incision.


RESULTS
Primary and secondary patency rates were 87 and 89%, respectively, at 1 year and 78 and 84%, respectively, at 2 years. Early complications included infection (3%) and haemorrhage (4%) and late complications included thrombosis (15%) and stenosis (14%).


CONCLUSIONS
The two-stage superficialized brachiobasilic AV fistula described in this article has good patency. The operative techniques are straightforward, have relatively low complication rates and result in a large-diameter fistula on the anteromedial aspect of the arm allowing easy and painless cannulation for haemodialysis.
Francis
David M A
DM
Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Austalia. dmafrancis@netspace.net.au
Lu
Yufan
Y
Robertson
Amanda J
AJ
Millar
Robert J
RJ
Amy
Jayne
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis