Is basilic vein transposition a real alternative to an arteriovenous bypass graft? A prospective study.
Basilic vein transpositions (BVTs) are considered to be superior to arteriovenous bypass grafts (AVGs). However, for the most part studies comparing BVTs to AVGs have been retrospective in design and without a set follow-up protocol. In this analysis, data were prospectively collected from patients with either a BVT or a brachio-axillary AVG. When all other native options were exhausted a BVT was performed if the vein had a diameter of 3 mm. All patients had bimonthly measurements of access inflow and recirculation using ultrasound dilution and were followed up for 2 years. Of 76 patients, 34 had a BVT and 42 an AVG (p > 0.05). BVT group: 12 were male, 22 female, the mean age was 62 and 26% were diabetic. AVG group: 22 were male, 20 female, the mean age was 57 and 56% were diabetic. The maturation delay was higher in the BVT group (6 weeks vs. 2 weeks). For the BVT and AVG groups, at 6, 12 and 24 months, respectively, primary patency was 90% vs. 76% (p < 0.05), 73% vs. 61% and 69% vs. 54% (p > 0.05). Assisted primary patency was 100% vs. 90% (p = 0.1201), 96% vs. 56% and 74% vs. 40% (p < 0.001). Secondary patency was 100% vs. 83%, 93% vs. 70% (p < 0.025) and 85% vs. 62% (p < 0.01). In the BVT group, 18 patients had 32 interventions for a total cost of $127,800, while in the AVG group, 27 patients had 54 interventions for a total cost of $227,300. This is the first prospective study to confirm that BVTs were cost effective and associated with better outcomes when compared with AVGs.
Chemla
Eric S
ES
St George's Healthcare NHS Trust, London, United Kingdom. eric.chemla@stgeorges.nhs.uk
Morsy
Mohamed A
MA
D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology; D014680:Veins / Q000601:surgery*