title: Placement of wrist ulnar-basilic autogenous arteriovenous access for hemodialysis in adults and children using microsurgery.
abstract: OBJECTIVE
  The distal basilic forearm vein is frequently preserved and might be used more frequently for placement of an ulnar-basilic autogenous arteriovenous access (UB-AAVA) in the wrist despite the small size of the two vessels. The scarcity of publications led us to initiate a prospective study regarding the placement and outcomes of UB-AAVAs.
  
  
  METHODS
  Seventy patients (63 adults, seven children) with no usable cephalic vein in either forearm were selected consecutively over 4 years for placement of a UB-AAVA. The prerequisite was a clinically visible or palpable forearm basilic vein after placing a tourniquet. Regional anesthesia, prophylactic hemostasis, and a surgical microscope were used systematically. Secondary superficialization was performed in two patients. Most non-matured accesses were abandoned in favor of the placement of a more proximal autogenous access. Mean follow-up was 20 months (SD =15).
  
  
  RESULTS
  Immediate patency was obtained in 94% of adults and 100% of children. Success (in-use access) was achieved in 60% of patients (38/63 adults and 6/7 children) after a mean postoperative interval of 80 days (SD = 64; range, 31-277). Failures included four immediate thromboses, one postoperative death, and 21 never-matured accesses. No steal syndrome was observed. Initial failures included, primary patency rates in adults at 1 and 2 years were 42% ± 6% and 30% ± 7%, respectively; secondary patency rates at 1 year and 2 years were 60% ± 6% and 53% ± 7%, respectively.
  
  
  CONCLUSIONS
  Although patency rates are not as good as those achieved with radial cephalic-AAVA, the UB-AAVA is an alternative autogenous forearm access before the placement of any other access involving the basilic vein. The use of the surgical microscope is mandatory, and more than usual time is required to achieve maturation.
authors.affiliation: Department of Angioaccess Surgery, Clinique, Jouvenet, Paris, France. pbourquelot@sfav.org
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourquelot
authors.forename: Olivier
authors.initials: O
authors.lastname: Van-Laere
authors.forename: Georges
authors.initials: G
authors.lastname: Baaklini
authors.forename: Luc
authors.initials: L
authors.lastname: Turmel-Rodrigues
authors.forename: Gilbert
authors.initials: G
authors.lastname: Franco
authors.forename: Julien
authors.initials: J
authors.lastname: Gaudric
authors.forename: Alain
authors.initials: A
authors.lastname: Raynaud
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002648:Child; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000601:surgery*; D014654:Vascular Patency; D014953:Wrist / Q000098:blood supply*; D055815:Young Adult