title: Efficacy of the Ulnar-Basilic Arteriovenous Fistula for Hemodialysis: A Systematic Review.
abstract: BACKGROUND
  The fistula first initiative has promoted arteriovenous fistulas (AVFs) as the vascular access of choice. To preserve as many future access options as possible, multiple guidelines advocate that the most distal AVF possible should be created in the first place. Generally, snuff box and radiocephalic (RC) are accepted and well-described sites for AVFs; however, the forearm ulnar-basilic (UB) AVF is seldom used or recommended. The aim of this study is to assess and systematically review the evidence base for the creation of the UB fistula and to critically appraise whether more attention should be given to this site.
  
  
  METHODS
  Electronic databases were searched for studies involving the creation of UB fistulas for dialysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes for this study were 1-year primary and secondary patency rates. Secondary outcomes were rates of hemodialysis access-induced distal ischemia (HAIDI) and infection.
  
  
  RESULTS
  After strict inclusion and/or exclusion criteria by 2 reviewers, 8 studies were included in our review. Weighted-pooled data reveal 1-year primary patency rate for UB AVFs of 53.0% (95% confidence interval [CI]: 40.1-65.8%) with a secondary patency rate of 72.0% (95% CI: 59.2-83.3). HAIDI and infection rates were low.
  
  
  CONCLUSIONS
  Our review has shown that the UB AVF may be a viable alternative when a RC AVF is not possible, and dialysis is not required urgently. It has adequate 1-year primary and secondary patency rates and extremely low risk of HAIDI. While it may be more challenging for both surgeons and dialysis nurses to make it a successful vascular access it offers a further option of distal access which may be overlooked.
authors.affiliation: Department of Renal Surgery, University Hospital Birmingham, Birmingham, UK; ReDVA Research Consortium, Dundee, UK. Electronic address: j.alshakarchi@nhs.net.
authors.forename: Julien
authors.initials: J
authors.lastname: Al Shakarchi
authors.affiliation: Department of Renal Surgery, University Hospital Birmingham, Birmingham, UK; ReDVA Research Consortium, Dundee, UK.
authors.forename: Aurangzaib
authors.initials: A
authors.lastname: Khawaja
authors.affiliation: ReDVA Research Consortium, Dundee, UK; Medical Research Institute, University of Dundee, Dundee, UK.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Cassidy
authors.affiliation: ReDVA Research Consortium, Dundee, UK; Medical Research Institute, University of Dundee, Dundee, UK.
authors.forename: J Graeme
authors.initials: JG
authors.lastname: Houston
authors.affiliation: Department of Renal Surgery, University Hospital Birmingham, Birmingham, UK; ReDVA Research Consortium, Dundee, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Inston
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000209:etiology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000503:physiopathology / Q000601:surgery*; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000601:surgery*