A Comparison of Transposed Brachiobasilic Fistulae with Nontransposed Fistulae and Grafts in the Fistula First Era

Abstract

This retrospective study compares outcomes of transposed brachiobasilic fistulae (avf), nontransposed avf, and grafts (avg). There were 161 (21%) transposed avf, 321 (42%) nontransposed avf, and 285 (37%) avg placed and followed over a 3-year period. Of the nontransposed avf, 203 (63%) were forearm radiocephalic avf and 118 (37%) were upper arm brachiocephalic avf. Grafts were able to be used in shorter time than avf and had a lower primary failure rate. However, avg had a significantly higher infection rate (0.23/patient/year vs. 0.07/patient/year) and required more procedures over the life of the access than avf (2.90/patient/year vs. 0.51/patient/year). Despite a higher primary failure rate, avf had better overall patency. Among nontransposed avf, brachiocephalic avf had significantly better primary patency than radiocephalic avf (p < 0.0001). Transposed avf had better cumulative patency than either nontransposed avf or grafts (p < 0.0001). Cumulative patency was best for transposed avf, intermediate for brachiocephalic avf, and worst with radiocephalic avf and avg. There was no difference in cumulative patency between radiocephalic avf and grafts (p = 0.5601). This analysis supports the current recommendation to prefer transposed avf over avg. In addition, the data suggest that both nontransposed brachiocephalic avf and transposed brachiobasilic avf outcomes may be superior to radiocephalic fistulae.

A comparison between one- and two-stage brachiobasilic arteriovenous fistulas

“…Several studies have compared various BBAVF with AVG. 3,[11][12][13][14][15][16][17][18][19] In particular, if the patient is already undergoing dialysis via a central venous permacath, one must weigh the risks of prolonged central vein catheterization while awaiting BBAVF maturation with the increased complication rate associated with AVG placement. A previous study showed an increased rate of thrombosis with AV graft compared with BBAVF (relative risk, 2.6; 95% CI, 1.3-5.3).…”

Early follow-up results of arteriovenous fistulae created for hemodialysis

“…Fistula prevalence also increased from 33% in 2003 to 41% in 2005 1. Patients with end-stage renal failure need to receive hemodialysis through an effective arteriovenous fistula (AVF) until renal transplantation.…”

Comprehensive Comparison of the Performance of Autogenous Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Forearm Loop Arteriovenous Graft in a Multiethnic Asian Hemodialysis Population

“…However, the early thrombosis rate of the BB AVGs in our series was 24.3% (10/41), which was higher than the reported 6.7 to 15.7% [5, 15]. We attempted to explore if the graft material played a role in early AVG thrombosis.…”

“…Current recommendations are for either an autogenous BBTAVF or a forearm loop BB AVG. Several studies have favoured the BBTAVF over the forearm loop BB AVG procedure on the basis of better patency rates and fewer interventions [5, 6, 15]. However, these studies report only the outcomes from accesses that were successful initially and primary failure cases were excluded from the analysis.…”