Basilic vein superficialization for hemodialysis vascular access

Abstract

Background:This study aims to discuss the outcomes of superficialization of basilic vein technique in brachiobasilic arteriovenous fistula formation and to present our experience. Methods: Between January 2006 and January 2012, 170 patients (74 males, 96 females; mean age 60.7±9.1 years; range 31 to 83 years) who underwent basilic vein superficialization surgery in our clinic were included. All patients were examined under Doppler ultrasonography preoperatively. Demographic data of the patients, maturation time and complications were recorded. The mean follow-up was 12 months. Results: Non-dominant upper limb was preferred for surgery. Of the 170 patients who were operated, 166 (97.6%) underwent hemodialysis. The mean maturation time was 61 days. Massive bleeding in the postoperative period occurred in two patients (1.2%). Wound infection was observed in eight patients (4.7%) in the early postoperative period. The most common reason for primary failure was thrombosis, which was observed in 48 patients (28.2%). The primary and secondary patency rates of the fistulas were 77% and 82%, respectively at one-year. Conclusion: Arteriovenous fistula formation through superficialization of the basilic vein offers satisfactory results in chronic hemodialysis patients with reasonable postoperative complication rate.

Long-term results for basilic vein superficialization or transposition for hemodialysis access

“…[1] The principal options for arteriovenous access in patients in whom the cephalic vein cannot be employed due to inappropriate structure or previous interventions are brachiobasilic AVF (BBAVF) or arteriovenous graft (AVG). [1][2][3][4][5] Although earlier cannulation is possible with AVG applications, the BBAVF has lower complication and higher patency rates. [3,4] According to the clinical practice guidelines of the European Society for Vascular Surgery published in 2018, autogenous AVF options should be preferred to synthetic grafts for hemodialysis patients owing to their low postoperative complication rates and fewer requirements for endovascular or surgical revision due to AVF failure.…”

“…[1][2][3][4][5] Although earlier cannulation is possible with AVG applications, the BBAVF has lower complication and higher patency rates. [3,4] According to the clinical practice guidelines of the European Society for Vascular Surgery published in 2018, autogenous AVF options should be preferred to synthetic grafts for hemodialysis patients owing to their low postoperative complication rates and fewer requirements for endovascular or surgical revision due to AVF failure. Single-or two-stage BBAVF in the upper extremity has been described as a good option, when AVF cannot be established with the cephalic vein, or in the event of failed radial-cephalic or brachial-cephalic AVF.…”

“…[1,2] Different surgical techniques have, to date, been described involving single-or two-stage superficialization only or simultaneous transposition of the basilic vein. [1][2][3][4][5]8,9] Several studies have compared the patency and complication rates of BBAVF techniques with those of other AVFs and AVG. [1,2] Promising results have been recorded for BBAVF, and it has entered the guidelines as superior to AVG, in particular.…”

Basilic vein transposition should be the first option

“…According to the National Kidney Foundation, patients should be considered for transposed basilic vein fistula after using the wrist radiocephalic and elbow brachiocephalic fistulas. If upper arm bridge grafts are used before the basilic vein, performing the basilic vein transposition technique can be impossible or very difficult because of the inefficient mobility of the proximal basilic or axillary vein after occlusion of the bridge graft fistulas ( 3 , 4 ).…”