Arteriovenous fistulas (AVFs) consist of the preferable choice for patients needing hemodialysis. They have lower morbidity, mortality rates, and cost compared with grafts or catheters. Brachial vein transposition BVT-AVF is an alternative native option for creating an AVF. Brachial vein superficialization was first reported by Paul G. Koontz and Thomas S. Helling in 1983.1 The method was conceived for patients with chronic renal failure (CRF) lacking adequate superficial veins for fistulas, mostly for individuals who have already undergone a large number of access operations. Brachial vein transposition AVF can be performed as one-or two-stage procedure; both methods have advantages and disadvantages. We collected and reviewed all published data concerning transposition and superficialization of the brachial vein as an
AbstractPurpose The purpose of the study was to investigate the patency rate of the brachial vein transposition-arteriovenous fistula [BVT-AVF] and to review the available literature regarding the comparison of the one-stage with the two-stage procedure. Methods A multiple electronic health database search was performed, aiming to identify studies on brachial vein superficialization. Case reports and series with five or less patients were excluded from the study. End points of the study were the patency rates at 12, 24, and 36 months of follow-up. The patency of the one-or two-stage BVT-AVF procedure was investigated. Results Overall, 380 BVT-AVFs were analyzed. The primary patency rate at 12 months ranged between 24 and 77%. Rate of early fistula malfunction or failure of maturation of the fistula resulting in loss of functionality ranged from 0 to 53%. Forearm edema, hematomas, wound infection, and early thrombosis were among the most common complications. Limited data were available for the comparison of patency rates between the one-and the two-stage procedure because of the absence of sufficient comparative studies. However, series with one-stage procedure presented a lower patency rate at 12 months compared to series with two stages. Conclusion Patency rates after BVT-AVF, although not excellent, has encouraging results taking into account that patients undergoing these procedures do not have an accessible superficial vein network; failure of maturation and the increased rate of early postoperative complications remain a concern. The BVT-AVF is a valuable option for creating an autologous vascular access in patients lacking adequate superficial veins.