Comparison of outcomes of one-stage basilic vein transpositions and two-stage basilic vein transpositions.
BACKGROUND
Basilic vein transpositions (BVTs) provide autologous hemodialysis access in the upper extremity. We report and compare our experience using the two techniques that are commonly performed to create BVTs: the one-stage and the two-stage technique.


METHODS
A retrospective review was performed on patients who underwent BVT from June 2006 to June 2010 from a database of all patients undergoing dialysis access procedures. One hundred six patients, mean age of 54 years (41% male), who received upper-arm basilic vein-only transposition were identified and were stratified based on one-stage and two-stage BVTs. Anatomic outcomes and functionality were determined and compared between stages.


RESULTS
Seventy-seven patients underwent two-stage BVT, and 29 underwent one-stage BVT. Fifty-one percent and 79% of the two-stage group and the one-stage group, respectively, had had a previous failed ipsilateral permanent access. Catheter dialysis at time of surgery was 14% in one-stage BVT and 43% in two-stage BVT. Immediate technical success was obtained in all cases. The rate of primary failure was 21% in the one-stage group and 18% in the two-stage group. Reintervention rates for the one-stage group and the two-stage group were 62% and 66%, respectively. Primary patency for the one-stage group and the two-stage group at 1 year was 82% and 67%, at 2 years was 81% and 27%, and at 3 years was 51% and 18%, respectively. Secondary patency for the one-stage group and the two-stage group at 1 year was 91% and 81%, at 2 years was 80% and 61%, and at 3 years was 58% and 45%, respectively. Thirty-day mortality was 0% in both groups, and all-cause morbidity was 12% in both groups (counting all stages).


CONCLUSIONS
One-stage BVTs have a similar number of initial failures and secondary interventions as two-stage BVTs. One-stage BVTs achieved better primary and cumulative patencies. There appears to be no advantage to a two-stage BVT in equally matched patients.
Dialysis Access Program, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX 77030, USA.
Fahad A
FA
Syed
Christopher J
CJ
Smolock
Cassidy
C
Duran
Javier E
JE
Anaya-Ayala
Joseph J
JJ
Naoum
Tam T
TT
Hyunh
Eric K
EK
Peden
Mark G
MG
Davies
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001916:Brachial Artery / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D017211:Treatment Failure; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000601:surgery