Single-stage basilic vein transposition—An effective and viable autogenous access for dialysis

Abstract

Introduction The National Kidney Foundation’s/Kidney Disease Outcomes Quality Initiative recommends autogenous arteriovenous fistulas as the preferred method for long-term hemodialysis access. Basilic vein transposition is not only an alternative in patients with failed arteriovenous access but also can be the first option for arteriovenous access in patients with inadequate cephalic vein. Several studies have shown better patency rates, cost-effectiveness, and fewer complications of autogenous access over prosthetic arteriovenous grafts. Aims and objectives To analyze patency, complication rates, and outcomes of single-stage basilic vein transposition. Materials and methods A single-center retrospective non-randomized study conducted at Ramaiah Medical College and Hospitals, Bangalore from July 2015 to June 2018. A total of 94 consented patients who underwent single-stage basilic vein transposition were included in the study. All the surgeries were done in a single stage under regional anesthesia. All the complications and patency rates were calculated at the end of one year. Statistical analysis was performed using the Chi-square test, and patency rates were assessed using the Kaplan–Meir survival curve. Results A total of 94 single-stage basilic vein transposition was performed. Fifty-four patients had a previous failed autogenous access and 40 had either absent or thrombosed cephalic vein. The mean age was 56.6 years with 59.57% males. The mean basilic vein and brachial artery diameter was 3.6 and 3.8 mm, respectively. The primary patency rate at one year was 84%. Edema and thrombosis were the most common complication in our study. Conclusion Single-stage basilic vein transposition is a feasible surgical option in end-stage renal disease patients and provides durable autogenous access with very reasonable outcomes in terms of complication rates and patency rates.