Clinical Study of Brachial Vein Transposition Fistulas for Hemodialysis / 日本心臓血管外科学会雑誌

Brachial vein transposition fistulas for hemodialysis are embloyed when the superficial veins in arms are not used. In our hospital, 28 patients have received brachial vein transposition fistula in the past 13 years. Post-operative complications were bleeding at the puncture sites in 2 patients, infection at the puncture site in 1, and aneurysm formation in the transposed vein in 1. Access related hand ischemia and venous hypertension were not recognized. For 3 patients of fistula stenosis, percutaneous catheter dilatation was performed. For 2 of 19 patients with fistula occlusion, surgical thrombectomy was performed. The primary patency rates were 76.8% at 1 year and 55.8% at 4 years. The secondary patency rates were 95.5% at 1 year and 66.3% at 4 years. The brachial vein transposition procedure is useful for long-term continuation of hemodialysis using autologous arm vessels.

Arteriovenous Fistula Creation through Basilic Vein Transposition in an Upper Extremity

PURPOSE: Autogenous arteriovenous access for chronic hemodialysis is recommended by the National Kidney Foundation- Dialysis Outcomes Quality Initiative practice guidelines. A transposed basilic vein to brachial artery arteriovenous fistula provides secondary vascular access for hemodialysis we assess outcomes of basilic vein transposition in arteriovenous fistula in this retrospective series. METHODS: We performed a retrospective review of 81 patients undergoing basilic vein transposition (BVT) in the Soonchunhyang University College of Medicine between January 2000 and December 2006. Age, sex, etiology of end-stage renal disease, and complications were tabulated. Primary and secondary patency rates were determined using Kaplan-Meier methods. RESULTS: The average age was 58 years old and 43 patients were male. Renal failure was associated with hypertension in 59 patients (73%), diabetes in 30 patients (37%), and BVT was the primary access procedure in 19 patients (23%). Follow-up was between 12 to 84 months. There was no operation-related deaths. Seven patients required prosthetic graft interposition because of shortness of the basilic vein. Primary and secondary patency rates were 74% and 93%, respectively, at 1 year, and 73% and 87% at 2 years. Thirty five postoperative complications developed in 21 patients, including thrombosis (1), proximal vein stenosis (17), arm swelling (1), central vein stenosis (10), bleeding with hematoma (1), wound seroma (2), steal syndrome (2) and aneurysm (1). The seven patients who required subsequent prosthetic grafting for a failed basilic vein arteriovenous fistula had an ipsilateral procedure. CONCLUSION: BVT arteriovenous fistula techniques provide a good patency rate. The complication rate, although high, is lower than that reported for PTFE grafts. Chronic renal failure with hemodialysis patients might benefit from BVT, because of long patency, less radiologic procedure, and lower infection rates. The BVT fistula should be used in preference to PTFE grafts for secondary access.

Basilic Vein Transposition as a Salvage for Failed Vascular Access for Hemodialysis

PURPOSE: Maintenance of a functioning vascular access in patients on hemodialysis is very important. To salvage patients with previous access complications, we performed basilic vein transposition in the upper arm or forearm. The purpose of this study was to evaluate the efficacy of basilic vein transposition in cases with hemodialysis graft complications. METHOD: Between March 2004 and August 2007, 11 patients received a basilic vein transposition (BVT) arteriovenous fistula as salvage for failed autogenous or prosthetic vascular access. The medical records and dialysis records were reviewed retrospectively. RESULT: The mean age was 60 (41~71) years and seven patients were male. The most common cause for the renal failure was diabetes in five cases. Upper arm BVT was performed in three patients and forearm BVT in another eight patients. There was no maturation failure. The mean time to maturation time was 45+/-15.5 days. The mean follow-up period was 14.5 months. During this period, two patients developed stenoses that were treated by balloon angioplasty, and two patients died with a patent fistula. The cumulative primary patency rate was 70%. There was no failed fistula during the follow up period. CONCLUSION: Autogenous BVT is a feasible salvage operation for failed vascular access. A BVT should be considered in complicated cases and as primary vascular access.