Transposed brachiobasilic fistula or PTFE arm graft - alternative or complementary?
OBJECTIVE
Our primary aims were (1) to examine the patency of transposed brachiobasilic (TBB) fistulae compared to arm arteriovenous graft (AVG) without prior transposition, and (2) to examine the patency of AVG with and without prior transposition.


METHODS
Single institution; analysis of prospectively collected data between January 2001 and January 2007. Dedicated database and medical records were reviewed and results analyzed with SPSS.


RESULTS
Ninety-one patients underwent 111 procedures (52 TBB: 39 AVG as index); 28 TBB failed with 17 (60%) being replaced with an ipsilateral AVG. TBB compared to AVG (without prior TBB) had significantly (log rank <0.05 ) better primary, primary assisted and secondary patency. Secondary patency at 2 yrs was 47% to 33%, respectively. Ipsilateral AVG after TBB to primary AVG had superior patency rates (secondary patency at 2 yrs 52 vs. 33%) but did not reach significance (log rank =0.073). Combined secondary patency of TBB and AVG after TBB was 81% at 2 yrs.


CONCLUSIONS
The TBB offers an autogenous fistula in the upper arm which has superior patency rates to an arm AVG. Once a TBB has failed an ipsilateral AVG is technically feasible and may offer better patency than a primary AVG.
Milburn
J A
JA
Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland. j.milburn@nhs.net
Lo
S T
ST
Szucs
Z J
ZJ
Humphrey
A
A
Macaulay
E M
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery; D016121:Brachiocephalic Veins; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D011475:Prosthesis Failure; D006435:Renal Dialysis; D015996:Survival Rate; D014654:Vascular Patency
D011138:Polytetrafluoroethylene