Basilic elevation transposition may improve the clinical outcomes for superficialization of basilic arteriovenous fistula veins

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Abstract

Objective:

Basilic vein arteriovenous fistulas are an important and common option for hemodialysis access and require superficialization before use. Various superficialization techniques have been employed, such as basilic tunnel transposition (BTT), basilic elevation, and basilic elevation transposition (BET). Each technique may have advantages and disadvantages, and there have been few reports directly comparing the outcomes of these techniques. This report compares the clinical outcomes of BET vs BTT performed by a single operator and discusses some technical considerations derived from this study and the literature.

Methods:

The demographic and outcome data of patients who underwent second-stage basilic vein transposition at an ambulatory surgery center from February 2009 to January 2016 were collected and analyzed.

Results:

Of the 99 patients identified, 53% were male and 64% were diabetic; the mean age was 61 ± 16 years; 27 had BTT and 72 had BET; the mean follow-up was 26.2 ± 20.5 (range, 1–83) months. The primary patency, assisted primary patency, and secondary patency rates of the whole fistula conduit were 26%, 91%, and 100% for the BTT group and 46%, 98%, 100% for the BET group at 1 year and 21%, 80%, 94% for the BTT group and 38%, 98%, 98% for the BET group at 2 years. The primary patency rate of the basilic vein (segment of the fistula conduit superficialized by transposition) at 1 year was significantly lower for the BTT group vs the BET group (26% vs 61%; P = .004). The average number of percutaneous interventions required for the basilic vein was significantly more for the BTT group vs the BET group (1.5 ± 1.3 vs 0.6 ± 1.0/access-year; P = .007). Based on a Cox regression analysis, the surgical techniques were the only clinical factor that significantly affected the basilic vein primary patency (hazard ratio of 2.28 in favor of BET over BTT; 95% confidence interval, 1.25–4.14; P = .007).

Conclusions:

BET is a reliable approach that yields a high cumulative fistula survival rate. Compared with BTT, BET is associated with improved basilic vein primary patency and reduced need for endovascular interventions.

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