Long-term Outcomes of Brachiobasilic Transposition Fistula for Haemodialysis

Taghizadeh, Arash; Dasgupta, Prokar; Khan, Mohd Shahbaaz; Taylor, J.; Koffman, G.

doi:10.1016/j.ejvs.2003.09.002

Cited by 82 publications

(73 citation statements)

References 13 publications

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“…Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).…”

mentioning

confidence: 99%

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

148

100

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In recent literature, surgically created hemodialysis (HD) arteriovenous fistulas (AVF) have high rates of primary failure. Endovascular treatment holds promise to salvage these fistulae. The outcomes of 119 patients who had a "failing to mature" AVF and presented for endovascular management were evaluated prospectively. All patients underwent a fistulogram. Stenotic lesions underwent balloon angioplasty, and accessory veins underwent obliteration. Technical success was determined immediately after the procedure. AVF salvage was determined by successful use during HD. Patients were followed up for 1 yr, during which primary and secondary AVF patency rates were measured. T he low prevalence of the arteriovenous fistula (AVF) among US hemodialysis (HD) patients (1,2) has initiated nationwide measures to increase AVF creation and prevalence (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Among these are providing educational programs, setting forth guidelines and goals (3,4), implementing multidisciplinary approaches (4 -9), encouraging preoperative venous mapping (14 -19), and asking surgeons to create AVF instead of arteriovenous grafts (AVG) (10 -21).Overall, an increase in AVF prevalence is occurring in the United States, albeit at a slow rate (14 -20). One impediment has been high primary failure rates, which in recent series ranged between 23 and 46% (9,(12)(13)(14). The use of ultrasound or other means of preoperative venous mapping is likely to decrease the incidence of primary AVF failures (14 -19). However, the increasing demand to create more fistulas may lead to their creation in borderline vessels, thereby increasing primary failure rates (21-23). Thus, salvage of these primary failures will be essential for increasing AVF prevalence in the United States.In our dedicated endovascular suite, we used percutaneous angioplasty and accessory vein obliteration in attempts to salvage fistulas with primary failure. Because most did not present with thrombosis, we elected to refer to their fistulas as "failing to mature." In this article, we report our initial success rates as well as follow-up on a series of 119 consecutive patients who were referred for salvage of their "failing to mature" AVF. Materials and Methods DefinitionsThe "failing to mature" AVF in our series was defined as an AVF that had been created for at least 8 wk but had not matured enough to allow successful cannulation or use during HD. This includes (1) fistulas that were never cannulated for HD be cause of obvious lack of maturity; (2) fistulas that failed first cannulation attempts and were abandoned; (3) fistulas that were cannulated successfully but could not be used because the blood flow was insufficient to sustain HD; this may have been because of high venous pressure or poor arterial inflow; and (4) fistulas that thrombosed before any attempts at HD. Juxta-arterial anastomosis segment refers to the initial 5 cm of the AVF starting at the arterial anastomosis. Peripheral vein refers to the venous outflow tract of t...

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mentioning

confidence: 99%

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Nassar

Nguyen

Rhee

et al. 2006

Clinical Journal of the American Society of Nephrology

148

100

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“…Literatürde SV greft ve BVT ile ikincil AVF oluşturulmasının etkinlik ve açık kalım üzerine karşılaştırılmasını amaçlayan çalışmaya rastlanmamıştır. BVT ile yapılan muhtelif çalışmalarda (13,14,15,16) BVT'nin ikincil AVF oluşturulmasında iyi bir seçenek oluşturduğu vurgulanmıştır. Basilik ven (BV) üst ekstremitedeki derin yerleşimine bağlı olarak iatrojenik hasarlanmalara karşı çoğu kez korunmuş durumdadır.…”

Section: Discussionunclassified

Saphenous Vein or Basilic Vein Transposition in Hemodialysis Patients?

Odabaşı¹,

Arı²,

Ekim³

2011

Turk Neph Dial Transpl

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ÖZAMAç: Safen ven (SV) greft ve basilik ven transpozisyonu (BVT) ile ikincil arteriyo-venöz fistül (AVF) oluşturulması hemodiyaliz (HD) için damar giriş yolu oluşturulmasında iyi bir seçenek oluştururlar. Eş zamanlı olarak ikincil AVF oluşturulmuş hasta serileri açık kalım ve komplikasyon oranları yönünden gözden geçirildi. GErEÇ ve YÖNTEMlEr:Ocak 2006 ile ocak 2010 tarihleri arasında 40 ikincil HD erişim işlemi ardışık 40 hastada uygulandı. Tüm erişim girişimleri kol ve önkolun operasyon öncesi dubleks ultrasonografi (USG) taramalarının ardından gerçekleştirilmiştir. İşlevsel açıklık hastada başarılı bir şekilde HD yapılabilmesi olarak tanımlanmıştır. SV greft ve BVT birincil ve ikincil olarak ve işlevsel açıklığın sağlanması "Kaplan Meier" yöntemi ile, açık kalma oranları arasındaki farklar Log-Rank testi ile, tomboliz, trombektomi ve operasyonel gözden geçirme gibi gözden geçirme oranları arasındaki farklar Z testi ve Fisher Exact T testi ile belirlenmiştir.BUlGUlAr: Ortalama izlem süresi 48 ay idi ( 43-54 ay). Her iki grubun risk faktörleri benzer idi. SV greft grubu ve BVT için açık kalım oranları arasında fark yoktu. HD giriş komplikasyonları SV greft grubunda daha fazla idi.SoNUÇ: Üst ekstremitesinde ikincil AVF açılması gereken hastalarda anatomik ölçütlere bağlı olarak bulgularımızdan kuvvetle çıkan önerme bazilik ven transpozisyonu safen ven greftinden önce düşünülebilir.AnAhtAR SÖZCÜkleR: Hemodiyaliz, Safen ven greft, Basilik ven transpozisyonu, Arteriyovenöz fistül ABStRACt oBjECTıVE: Secondary arteriovenous fistula (AVF) management with saphenous vein (SV) graft and basilic vein transposition (BVT) in HD-dependent patients are good alternatives. A concurrent series of patients was reviewed to evaluate the patency and complication rates after AVF formation. MATErıAl and MethoDS:From January 2006 to January 2010, 40 secondary HD access procedures were performed in 40 consecutive patients. All access procedures were planned on the basis of preoperative duplex ultrasonography (USG) scans of arm and forearm veins. Functional patency was defined as the ability to cannulate the patient for HD successfully. Primary and secondary cumulative functional patency of SV grafts and BVT's were determined with the Kaplan Meier test, differences were analyzed with Log Rank test, and differences in revision rates including thrombolysis thrombectomies and operative revisions were analyzed with the Z test and the Fisher exact T test. rESUlTS: Mean follow up was 48 months (range 43-54 months). Risk factors were similar between the two groups. SV group and BVT group had similar patency ratings. The HD access complication rates were higher in the SV group. CoNClUSıoN: Our data strongly support the notion that the BVT must always be considered before an SV graft as long as the patient is a candidate for an upper arm secondary AVF creation based on anatomical criteria.

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“…16 Reported prevalence of complications for BBAVF remains very high (≥71%). 13,22,23 These complications include large haematomas necessitating surgical evacuation, seromas and wound infection, often resulting from this invasive approach. However, these complications appear to be self-limiting.…”

Section: Discussionmentioning

confidence: 99%

Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency

Dellen

Junejo

Khambalia

et al. 2016

annals

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INTRODUCTION Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous 'real estate' but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. METHODS A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. RESULTS Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). CONCLUSION Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity.

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Long-term Outcomes of Brachiobasilic Transposition Fistula for Haemodialysis

Abstract: Brachiobasilic transposition fistulae have good long-term patency rates. The complication rate, although high, is lower than that reported for PTFE grafts. Brachiobasilic fistulae should be used in preference to PTFE grafts for secondary access.

Cited by 82 publications

References 13 publications

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Endovascular Treatment of the “Failing to Mature” Arteriovenous Fistula

Saphenous Vein or Basilic Vein Transposition in Hemodialysis Patients?

Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency

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