Two-stage basilic vein transposition-a new approach for pediatric dialysis access.
OBJECTIVE
The fistula first initiative has led to increased efforts to create arteriovenous fistulas (AVFs) as primary dialysis access. Two-stage basilic vein transposition (BVT) allows maturation of smaller veins, often a limiting factor in the pediatric population, before elevation and use. We sought to determine whether using 2-stage BVT improves maturation, use, and patency compared with other AVFs, including arteriovenous (AV) grafts.


METHODS
Thirty-one patients underwent AV access creation between 1997 and 2008. Data were collected on types of access, maturation, complications, and patency.


RESULTS
Forty-two AV access procedures were performed: 15 (36%) 2-stage BVT, 13 (31%) 1-stage BVT, 6 (14%) radiocephalic, 3 (7%) brachiocephalic, 1 (2%) brachiobrachial, and 4 (10%) AV grafts. Follow-up averaged 20.4 +/- 3.2 months for 2-stage BVT and 47.9+/-4.1 months for other AVFs (P < .001). All 2-stage BVT matured compared with 52% (14/27) of other AVFs (P = .001). More 2-stage BVTs (87%) were used for dialysis than other AVFs (48%, P = .024). Fistula failure occurred in 7% 2-stage BVT compared with 59% other AVFs (P = .001). One-year patency rates were 91% for 2-stage BVT vs 47% for other AVFs (P = .003).


CONCLUSIONS
Rates of fistula maturation, use, and patency are higher for 2-stage BVT with lower rates of failure. Two-stage BVT shows great promise as the preferred approach to creation of AVF in pediatric patients, especially those with smaller veins.
Kim
Anne C
AC
Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The CS Mott Children's Hospital, Ann Arbor, MI, USA.
McLean
Sean
S
Swearingen
Alissa M
AM
Graziano
Kathleen D
KD
Hirschl
Ronald B
RB
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D016121:Brachiocephalic Veins / Q000637:transplantation; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*; D016748:Venous Cutdown / Q000379:methods*