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

Abstract

Aim. For patients who have exhausted cephalic vein arteriovenous fistula (AVF) options, controversy exists on whether brachial-basilic AVF with transposition (BBTAVF) or a forearm arteriovenous graft (AVG) should be the next vascular access of choice. This study compared the outcomes of these two modalities. Methods. A retrospective study of 122 Asian multiethnic patients who underwent either a BBTAVF (81) or an AVG (41). Maturation time and intervention rates were analyzed. Functional primary, secondary, and overall patency rates were evaluated. Results. The maturation time for BBTAVFs was significantly longer than AVGs. There was also a longer deliberation time before surgeons abandon a failing BBTAVF compared to an AVG. Both functional primary and secondary patency rates were significantly higher in the BBTAVF group at 1-year follow-up: 73.2% versus 34.1% (p < 0.001) and 71.8% versus 54.3% (p = 0.022), respectively. AVGs also required more interventions to maintain patency. When maturation rates were considered, the overall patency of AVGs was initially superior in the first 25 weeks after creation and then became inferior afterwards. Conclusion. BBTAVFs had superior primary and functional patency and required less salvage interventions. The forearm AVG might have a role in patients who require early vascular access due to complications from central venous catheters or with limited life expectancy.

Beraprost sodium versus clopidogrel for preventing vascular thromboembolic events of arteriovenous fistula in uraemic patients: a retrospective study with a mean 3-year follow-up

“…This can improve vasospasm of the radial artery, increase blood flow of an internal fistula, and promote maturation of an internal fistula. 31,32…”

“…Chue et al. 32 showed that, in patients with ESRD, BPS was inferior to CL in delaying the time to first on-study VTE (HR 1.43; P = 0.001). However, Coleman et al.…”

Transposed Brachial–Basilic Arteriovenous Fistula for Vascular Access in Japan

“…Table 1 summarizes the main outcomes reported in various studies. 42 , 46 – 62 ) Chemla and Morsy found that TBBAVF offered a better patency rate with greater cost-effectiveness compared with brachio-axillary AVG. 53 ) Chue et al studied 122 Asian patients and reported that TBBAVF provided superior patency and required fewer salvage interventions compared with forearm AVG.…”

“… 53 ) Chue et al studied 122 Asian patients and reported that TBBAVF provided superior patency and required fewer salvage interventions compared with forearm AVG. 62 ) However, recent studies showed comparable patency between AVG and TBBAVF and have favored the use of prosthetic grafts in specific groups like elderly patients, because of the short cannulation period. 42 , 55 , 61 ) Overall, utilization of TBBAVF is associated with reduced risk of access failure, whereas AVG represents the preferred option for elderly patients.…”

Forearm loop arteriovenous grafts preserve and may create new upper arm access sites

“…[6][7][8] When patients are not candidates for wrist AVF, current guidelines recommend upper arm AVF if there is suitable vein; however, this decision of next access is controversial. [9][10][11][12] Currently, arteriovenous grafts (AVGs) are not recommended unless no suitable vein is available. Studies are limited regarding the outcomes of forearm loop arteriovenous graft (flAVG) with respect to their influence on upper arm superficial veins.…”