Ulnar-Basilic Arteriovenous Fistula for Hemodialysis Access: Utility as the “Second Procedure” after Radio Cephalic Fistula

Abstract

Objectives : As per standard guidelines, the recommended order of arteriovenous fistula (AVF) creation for hemodialysis (HD) access is radiocephalic (RC), followed by proximal elbow fistulas and arteriovenous graft. Although ulnar-basilic (UB) fistula has been an alternative to RC-AVF, still this procedure searches clear recommendations. We present here our experience on UB-AVF as the preferred “second procedure” instead of proximal fistula after the RC-AVF. Methods : Forty-two UB-AVF were created in nonfeasible and failed RC-AVF cases between 2016 and 2018. They were reviewed retrospectively and outcomes were compared with 480 RC-AVF constructed within the same period. Results : The primary patency at 18 months was 73.8%, 69.6% and mean maturation time was 33.7±6.6 days, 32.1±4.7 days for UB-AVF and RC-AVF respectively (p>0.05). Conclusion : Our altered order of preference enabled us to create all the first-time fistula in the distal forearm, providing all the advantages of distal fistula like RC-AVF and avoiding proximal fistula, improved patient convenience and short-term benefit. In an inference that may be used for references and needs support from a larger sample and longer duration study from other centers, UB-AVF may be considered as the second option after RC-AVF depending on the clinical scenario.

The challenging surgical vascular access creation

“…High rates of non-maturation a p p r o a c h i n g 5 0 % h a v e b e e n r e p o r t e d w i t h t h i s configuration theoretically owing to pre-existing vein sclerosis (41) as well as predisposition to juxta anastomotic stenosis that Shenoy et al (42) have attributed to various flow related factors. A basilic vein to ulnar artery fistula represents an underutilized option (43), particularly as the vein is frequently preserved and free of venipuncture trauma. This circuit must be secondarily transposed to the volar surface and we elect to do this in a staged fashion to facilitate patient comfort during dialysis.…”

"Fetal Anatomical Variability of the Veins of the Upper Limbs"

“…The basilic vein at the antebrachial level, as a rule, has an insufficient diameter and is extremely inconvenient for punctures during hemodialysis due to its topography. Also, there are data in the literature on variations of forming an arteriovenous fistula due to creating anastomoses of the cephalic or basilic vein with the brachial artery in the ulnar area 17 .…”