Outcomes for forearm and upper arm arteriovenous fistula creation with the transposition technique

Abstract

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.

Transposed brachio-basilic arterio-venous fistulae versus prosthetic arteriovenous grafts; mid-term results and a review of literature

“…Many of the existing studies concerning AVG and its role in long-term haemodialysis are retrospective [22,23,56] with only one prospective multicenter trial comparing AVG to TBB-AVF [35]. In summary, these studies found that while AVG provided comparable access patency, they carried higher rates of all-cause mortality, morbidity, re-intervention, readmission and overall institutional costs.…”

Outcomes of Patients Referred for Arteriovenous Fistula Construction: A Systematic Review

“…29 Prior to AVF creation, CVC use occurred in 35.7-77.4% of patients. 13,21,26,30,31 A study investigating the natural history of AVFs noted that 66% of vascular access procedures were to create an AVF, with 33% of these being RCAVFs. 26 Four studies reported that 48-75% of AVFs were being used for HD at the time of follow-up, while 37-51% of them were abandoned.…”

“…Four studies reported an average AVF maturation time of 148-285 days with a cumulative functional 1-year patency of 60-70%. 1,21,26,32 Primary failure was recorded in 3 studies and occurred in 20-26% of cases. 25,26,31 In one study, AVFs failed to mature 20% of the time.…”

“…12,20 In cases where the creation of a RCAVF is not feasible due to poor vasculature brachiocephalic, brachiobasilic, and brachiobrachial AVFs can be created. 21 In spite of the clear benefits provided by AVFs for HD patients, they do carry some drawbacks and can potentially pose a risk for serious complications requiring hospitalization. 22 The reported complications surrounding fistulas include aneurysm development, stenosis of the vein, dialysisassociated steal syndrome (due to ischemia), thrombosis, and infection.…”

“…1,[23][24][25] Indeed, AVFs are a source of patient morbidity, however, they still remain the principal type of vascular access for HD compared to AVGs or CVCs. 8,21 To ensure its success, the timing of AVF creation relative to HD must be considered. As there exists a long lag time between AVF formation and usage, fistulas can be created in a pre-emptive manner to circumvent potential CVC access, if HD is required.…”