title: Outcomes for forearm and upper arm arteriovenous fistula creation with the transposition technique.
abstract: OBJECTIVE
  To study the outcomes of three different types of arteriovenous fistula (AVF) transpositions (forearm cephalic vein transposition [FACVT], upper arm cephalic vein transposition [UACVT], and upper arm basilic vein transposition [UABVT]) for dialysis patients in a single center.
  
  
  METHODS
  A 6-year retrospective review, from 2006 to 2012, was conducted at a single institution in which the surgical outcomes for three different types of AVF transposition were reviewed. Preoperative duplex vein mapping was obtained in all patients to choose the best vein for access.
  
  
  RESULTS
  There were 165 patients identified with 77 FACVTs, 52 UACVTs, and 36 UABVTs. Primary access maturation rates for the FACVT, UACVT, and UABVT groups were 86%, 90%, and 97%, respectively (P = .19). All transposed, matured primary AVFs were used after a mean of 9.9 weeks, without additional intervention. Primary 1-year patency for the FACVT, UACVT, and UABVT groups were 63%, 61%, and 70%, respectively (P = .71). Primary assisted 1-year patency for the FACVT, UACVT, and UABVT groups were 93%, 93%, and 100%, respectively (P > .999). Mean operating room times and time to intervention were not significantly different between the groups. The postoperative hematoma rate was 2% and wound infection rate was 2%. Multivariate analysis indicated no significant predictors of time to failure (P > .05).
  
  
  CONCLUSIONS
  With low primary failure rates, reduced need for secondary interventions before maturation, and 1-year primary assisted patency rates in excess of 93%, our study showed that the transposition technique, in our experience, is superior to previously published literature in hemodialysis access creation.
authors.affiliation: Grand Rapids Medical Education Partners, Department of Vascular Surgery, Michigan State University, Grand Rapids, Mich. Electronic address: lkorepta@gmail.com.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Korepta
authors.affiliation: Division of Vascular Surgery, Spectrum Health Hospital, Grand Rapids, Mich.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Watson
authors.affiliation: Michigan State Medical School College of Human Medicine, Grand Rapids, Mich.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Elder
authors.affiliation: Department of Surgery, Michigan State University, Grand Rapids, Mich.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Division of Vascular Surgery, Spectrum Health Hospital, Grand Rapids, Mich; Department of Surgery, Michigan State University, Grand Rapids, Mich.
authors.forename: M Ashraf
authors.initials: MA
authors.lastname: Mansour
authors.affiliation: Division of Vascular Surgery, Spectrum Health Hospital, Grand Rapids, Mich.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Chambers
authors.affiliation: Division of Vascular Surgery, Spectrum Health Hospital, Grand Rapids, Mich.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cuff
authors.affiliation: Division of Vascular Surgery, Spectrum Health Hospital, Grand Rapids, Mich.
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency