title: Comparison among transposed brachiobasilic, brachiobrachial arteriovenous fistulas and Flixene™ vascular graft.
abstract: OBJECTIVE
  To compare the outcomes of 3 upper arm access types: transposed brachiobasilic arteriovenous fistula (BBAVF), autogenous brachial vein-brachial artery access (ABBA), and a new type of ePTFE graft (Flixene™ graft) (AVG), in a consecutive series of patients treated in a tertiary centre.
  
  
  METHODS
  A prospective, computerized access database was analysed retrospectively to identify all patients undergoing BBAVF, ABBA, or AVG between January 1, 2008, and December 31, 2009.
  
  
  RESULTS
  A total of 108 patients were identified; of whom 45 had BBAVF, 15 ABBA, and 48 ePTFE brachioaxillary AVG. Early failure was similar in all 3 groups. The 18-month functional patency rates for the ABBAs, BBAVFs, and grafts were 27%, 51%, and 55%, respectively. The median time to first use for AVGs was significantly shorter (p<0.0001). Complications were not more frequent in AVGs than ABBAs and BBAVFs (p=0.127). The total number of access interventions was similar between the AVG and ABBA groups (p=0.58), but it was significantly higher in the AVG group compared with the BBAVF group (p<0.0001).
  
  
  CONCLUSIONS
  This study supports the current recommendations of the NKF Kidney Disease Outcomes Quality Initiative for using BBAVFs as third choice after radiocephalic and brachiocephalic arteriovenous fistulas. We also showed good results with a new type of prosthetic graft (Flixene™ graft) that allows cannulation within days of implantation. We now favour the use of this graft instead of basilic vein transposition in elderly patients with short life expectancy and urgent need of renal access.
authors.affiliation: Department of Vascular Surgery, King's College Hospital, London, UK.
authors.forename: Christos
authors.initials: C
authors.lastname: Lioupis
authors.forename: Hiren
authors.initials: H
authors.lastname: Mistry
authors.forename: Tom
authors.initials: T
authors.lastname: Rix
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chandak
authors.forename: Mark
authors.initials: M
authors.lastname: Tyrrell
authors.forename: Domenico
authors.initials: D
authors.lastname: Valenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene