Brachial versus basilic vein dialysis fistulas: A comparison of maturation and patency rates

Abstract

Despite a higher rate of initial maturation in basilic vein transpositions, brachial and basilic vein transpositions had comparable patency rates at 12 months. These preliminary results require further follow-up and a larger cohort of patients for confirmation. Broader use of the brachial vein transposition for dialysis appears justified and can increase the overall percentage of autogenous fistula placement.

Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula

“…This AVF has the advantage of a higher patency rate than that of prosthetic grafts and a lower infection rate. [5][6][7] However, the disadvantages include longer operation time, longer maturation period required, possible vein damage during dissection, and frequent wound problems owing to the longer incision. The 1-year primary patency rates of the UBVT are reported as 23% to 90%, whereas 1-year secondary patency rates are 47% to 96%.…”

“…[2][3][4][5][6][7][8][9] Although this method has some disadvantages, including technical difficulty, longer operation times, and longer maturation duration, it is widely accepted because of better patency rates and fewer infection rates compared with prosthetic grafts.…”

The Brachio-Brachial Arteriovenous Fistula

“…To date, this is the largest reported cohort of patients with a brachio-brachial AVF. Other groups have reported 17 (Casey et al, 2008), 20 (Angle et al, 2005) and 21 patients (Elwakeel et al 2007). Thirty-nine patients (79,6%) had a functional fistula at the time of brachial vein transposition, after 4 weeks.…”

“…We believe that the absence of other complications like persistent forearm edema, ischemic lesions, etc, was related to the presence of two satellite brachial veins; therefore, the remaining brachial vein sustains the deep venous drainage. Other groups have reported a higher number of complications, including hematomas, wound infections (Casey, 2008) and steal syndrome which required reintervention and revascularization of the upper extremity. There were two cases of technical difficulties in mobilization of the brachial vein that had not been reported before: in one case we managed to maintain the native AVF (due to successful reconstruction of the arterialized vein in front of the median nerve) (figures 5 & 6), while in the other case where the arterialized vein remained too small, we were forced to make a prosthetic fistula.…”

Prophylactic Ligation of the Median Cubital Vein to Improve the Patency of a Radio Cephalic Fistula

“…Chronic kidney disease patients have to undergo battery of blood tests and antibiotics from the cephalic vein which is the most superficial and easily cannulated vein. But most of the blood flow will be transferred from the fistula to uncannulated high caliber basilic vein and it results in poor maturation of cephalic vein in the arm [9][10][11]. Hence prophylactic ligation of median cubital vein was chosen.…”