Quantitative evaluation of the systemic effects of transposed basilic vein to brachial artery arteriovenous fistula: a prospective study.
BACKGROUND
The transposed basilic vein to brachial artery arteriovenous fistula (BBAVF) constitutes an alternative autogenous vascular access (VA) site for chronic hemodialysis (HD); however, the hemodynamic effects of this procedure have not been adequately studied. The purpose of this study is to evaluate the effects of BBAVF on systemic arterial pressure, cardiac function, and upper limb ischemia (ischemic steal syndrome) utilizing reproducible quantitative methods.


METHODS
Ten consecutive patients (eight males; mean age: 65.10+/-2.87 yrs) scheduled to undergo a brachial-basilic vein transposition were included, excluding patients with cardiac failure. Blood flow volume at the level of the AVF, systemic arterial pressure (SAP), cardiac output (CO) and digital brachial index (DBI) were measured intra-operatively, before and after the creation of the BBAVF, and post-operatively on the 30th post-operative day and on the 3rd post-operative month.


RESULTS
SAP and DBI at 30 days and 3 months post-operatively were significantly lower compared to baseline. CO at 30 days and 3 months post-operatively was significantly higher compared to baseline; however, none of the patients developed cardiac failure. DBI remained >or=0.6 at 3 months, except in one case (0.59). Blood flow volume at the level of the AVF was positively correlated with CO levels on the 30th post-operative day. Mean clinical follow-up was 12 months (range: 4-15 months). In two cases (20%) the AVF was thrombosed (4th and 10th post-operative month).


CONCLUSIONS
This prospective quantitative study proves that the BBAVF does impact significantly upon SAP, CO, and DBI; however, it is safe in terms of high-output cardiac failure and ischemic steal syndrome. The authors state that they do not have any commercial, proprietary, or financial interest in any products or companies described in this article.
Saratzis
N
N
1st Department of Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Saratzis
A
A
Sarafidis
P A
PA
Melas
N
N
Ktenidis
K
K
Kiskinis
D
D
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001794:Blood Pressure; D001810:Blood Volume; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D002302:Cardiac Output; D016534:Cardiac Output, High / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013997:Time Factors; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins / Q000503:physiopathology / Q000601:surgery