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Brachial vein transposition arteriovenous fistulas for hemodialysis access Jennings WC; Sideman MJ; Taubman KE; Broughan TAJ Vasc Surg 2009[Nov]; 50 (5): 1121-5; discussion 1125-6BACKGROUND: An arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, offering lower morbidity, mortality, and cost compared with grafts or catheters. Patients with a difficult access extremity have often lost all superficial veins, and even basilic veins may be obliterated. We have used brachial vein transposition AVFs (BVT-AVFs) in these challenging patients and review our experience in this report. METHODS: The study reviewed consecutive patients in whom BVT-AVFs were created from September 2006 to March 2009. Most BVT-AVFs were created in staged procedures, with the second-stage transposition operations completed 4 to 6 weeks after the first-stage AVF operation. A single-stage BVT-AVF was created when the brachial vein diameter was > or =6 mm. RESULTS: We identified 58 BVT-AVF procedures, comprising 41 women (71.0%), 28 diabetic patients (48.3%), and 29 (50.0%) had previous access surgery. The operation was completed in two stages in 45 operations (77.6%) and was a primary transposition in 13 patients. However, five of these were secondary AVFs with previous distal AV grafts or AVFs placed elsewhere; effectively, late staged procedures. Follow-up was a mean of 11 months (range, 2.0-31.7 months). Primary patency, primary-assisted patency, and cumulative (secondary) patency were 52.0%, 84.9%, and 92.4% at 12 months and 46.2%, 75.5%, and 92.4% at 24 months, respectively. Harvesting the brachial vein was tedious and more difficult than harvesting other superficial veins. No prosthetic grafts were used. CONCLUSION: BVT-AVFs provide a suitable option for autogenous access when the basilic vein is absent in patients with difficult access extremities. Most patients required intervention for access maturation or maintenance. Most BVT-AVFs were created with staged procedures. Cumulative (secondary) patency was 92.4% at 24 months.|*Renal Dialysis[MESH]|*Tissue and Organ Harvesting[MESH]|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Arteriovenous Shunt, Surgical/adverse effects/*methods[MESH]|Brachial Artery/physiopathology/*surgery[MESH]|Brachiocephalic Veins/physiopathology/*transplantation[MESH]|Female[MESH]|Graft Occlusion, Vascular/etiology/physiopathology[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Radial Artery/physiopathology/*surgery[MESH]|Retrospective Studies[MESH]|Time Factors[MESH]|Transplantation, Autologous[MESH]|Treatment Outcome[MESH]|Vascular Patency[MESH]|Young Adult[MESH] |
