Should We Use Basilic Vein Transposition Instead of Prosthetic Graft for Creation of Secondary Arterio-Venous Fistula in Hemodialysis Dependent End Stage Renal Failure Patients

Abstract

Objective: Every end stage renal failure (ESRF) patient needs vascular access for hemodialysis (HD). Secondary arterio-venous fistula (AVF) constitution with prosthetic graft (PG) or basilic vein transposition (BVT) are good alternatives for patients who lost the chance of radio-cephalic arterio-venous fistula (RCAVF) or brachio-cephalic arterio-venous fistula (BCAVF). To evaluate the patency and complication rates after AVF formation a concurrent series of patients were reviewed. Material 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. Functional patency was defined as ability to cannulate for HD patient successfully. Primary and secondary cumulative functional patency of PG's and BVT's were determined with Kaplan Meier test, differences were analyzed with Log Rank test, 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 (43-54 months) months. Risk factors were similar between the two groups. BVT group has the better patency ratings. Steal syndrome and odema were higher in BVT group. Conclusion: As long as the patient is a candidate for an upper arm secondary AVF creation based on anatomical criteria BVT is always be considered before a PG. Copyright © 2011 by Türkiye Klinikleri.