title: Surgical and endovascular revision of brachio-basilic vein fistula.
abstract: OBJECTIVE
  The brachio-basilic vein fistula (BBVF) is currently the third vascular access option for patients on hemodialysis, following radio-cephalic and brachio-cephalic arterio-venous fistulas. Like all types of hemodialysis vascular access, a variety of procedures may have to be performed in order to maintain long-term use of the BBVF. The aim of the present study was to perform a literature review of endovascular or surgical revisions of BBVFs.
  
  
  METHODS
  On Pubmed search, 676 records were obtained and reviewed for relevance with the aim of the search.
  
  
  RESULTS
  A variety of endovascular and surgical revision techniques has been described to manage BBVF poor maturation, dysfunction manifested as failing BBVF (most often the result of a stenosis at the transposed/swing segment), thrombosis, aneurysm formation and hemodialysis access-induced hand ischemia (steal syndrome). The role of revision is crucial in BBVF maintenance, taking into account that around 70% of these fistulas will require some intervention by 18 months and as a result of revision, secondary patency is preserved in the vast majority, according to the results of one study. Endovascular revision is the treatment of choice for most cases of BBVF dysfunction or thrombosis, with redo surgery reserved for failures of endovascular techniques or other specific indications.
  
  
  CONCLUSIONS
  BBVF revision, more often in the form of endovascular surgery, plays a crucial role in BBVF maintenance and its continued use for hemodialysis, necessary for reducing graft and catheter use and the associated morbidity.
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Patras - Greece.
authors.forename: Stavros K
authors.initials: SK
authors.lastname: Kakkos
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Patras - Greece.
authors.forename: Anastasia K
authors.initials: AK
authors.lastname: Kouri
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Patras - Greece.
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Tsolakis
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Michigan - USA.
authors.forename: Georges K
authors.initials: GK
authors.lastname: Haddad
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Patras - Greece.
authors.forename: George C
authors.initials: GC
authors.lastname: Lampropoulos
authors.affiliation: Department of Interventional Radiology, University Hospital of Patras, Patras - Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karnabatidis
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy*; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017211:Treatment Failure; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000601:surgery*