title: Higher patency of transposed brachio-basilic arteriovenous fistulas compared to brachio-axillary grafts for hemodialysis patients.
abstract: OBJECTIVE
  We compared outcomes of transposed brachio-basilic arteriovenous fistulas (BBAVF) with brachio-axillary prosthetic grafts (BAPG) for hemodialysis.
  
  
  METHODS
  All consecutive patients who underwent creation of a BBAVF or a BAPG, in one of the two institutions, between January 2008 and December 2013 were retrospectively identified. We assessed functional patency and compared complication rates. Patency was also compared between one-stage and two-stage creation procedures for the BBAVF group.
  
  
  RESULTS
  Two hundred and thirty-eight patients underwent the creation of a BBAVF (N = 136) or a BAPG (N = 102). Median follow-up was 17 months (range, 1-79). At 6, 12 and 24 months, patients in the BBAVF group had significantly higher primary patency (80%, 69%, 56% vs. 77%, 56%, 37%, respectively; p = 0.005), assisted primary patency (90%, 80%, 71% vs. 80%, 66%, 48%; p&lt;0.0001) and secondary patency (93%, 84%, 72% vs. 94%, 87%, 62%; p = 0.006). Two-stage BBAVF had a significantly higher secondary patency (98%, 92%, 78% vs. 90%, 80%, 68%; p = 0.04) than one-stage BBAVF. The rate of infectious complications was significantly lower in the BBAVF group than in the BAPG group (0.8% vs. 6.9%; p = 0.03).
  
  
  CONCLUSIONS
  In this large cohort, BBAVF had a higher functional patency and lower rate of infectious complications than BAPG. After exhaustion of cephalic veins, we suggest creation of a BBAVF instead of BAPG, whenever anatomically feasible. The superiority of one-stage or two-stage BBAVF creation procedure must be further investigated.
authors.affiliation: Department of Vascular Surgery, University Hospital of Reims, Reims - France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Marques
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice - France.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sadaghianloo
authors.affiliation: Department of Vascular Surgery, University Hospital of Reims, Reims - France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fouilhé
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice - France.
authors.forename: Elixène
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice - France.
authors.forename: Serge
authors.initials: S
authors.lastname: Declemy
authors.affiliation: Department of Vascular Surgery, University Hospital of Reims, Reims - France.
authors.forename: Claude
authors.initials: C
authors.lastname: Clément
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice - France.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001367:Axillary Vein / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005602:France; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000503:physiopathology; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency