Modified two-stage basilic vein transposition for hemodialysis access

Paulson, Kari A.; Gordon, Victor; Flynn, Lisa; Lorelli, David R.

doi:10.1016/j.amjsurg.2010.06.037

Cited by 13 publications

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Good clinical outcomes were achieved when new arteriovenous anastomosis was routinely created during second-stage transposition based on a report of 49 patients. 24 In our opinion, a new arteriovenous anastomosis is helpful only when there is flow-limiting inflow stenosis, which affects only a small percentage of patients. The medial antebrachial cutaneous nerve usually accompanies the basilic vein along its path in the upper arm.…”

Section: Discussionmentioning

confidence: 92%

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

Wang

Jennings

2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 92%

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

Wang

Jennings

2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…The large benefit with staged procedures in patients with small and not arterialized veins precludes to our view any future trials; obviously, patients with bigger and non-arterialized veins, rare to recruit though, could be randomized into primary and staged TBBV fistula, in view of the recently reported long-term patency with the latter approach ( 6 ). Future work to our opinion should also focus on techniques to improve further staged procedures ( 11 ), including the direct comparison of superficialization with formal transposition.…”

Section: Discussionmentioning

confidence: 99%

“…The transposition procedure was performed at least 6 weeks later to allow the basilic vein to enlarge, guided by an interval CCDU to confirm this (desirable vein diameter ≥6 mm), using skip incisions, basilic vein transection, placement into the tunnel, and reanastomosis ( 5 ). Previously described modified techniques of basilic vein transposition, guided by the preoperative CCDU and operative findings were selectively used when indicated ( 11 – 13 ).…”

Section: Methodsmentioning

confidence: 99%

Randomized Controlled Trial Comparing Primary and Staged Basilic Vein Transposition

et al. 2015

View full text Add to dashboard Cite

ObjectiveIt is unclear if brachio-basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. Our aim was to report on a randomized controlled trial comparing these two techniques.MethodsSixteen patients with a basilic vein ≥2.5 mm were randomized into primary transposed brachio-basilic vein (TBBV) fistula (n = 9) and staged TBBV fistula (n = 7). Patients with basilic veins enlarged by previous arteriovenous fistulas were excluded. Baseline characteristics of the two study groups, including vein size, were comparable (median basilic vein diameter 3.5 mm, range 2.8–4.1 mm). The staged group had a brachio-basilic vein fistula performed first followed by the transposition procedure performed at least 6 weeks later to allow the basilic vein to enlarge. TBBV fistula maturation at 10 weeks, primary, assisted-primary, and secondary patency were the primary outcome measures. Early failures were included in the calculation of patency rates.ResultsTransposed brachio-basilic vein fistula maturation rate after primary procedures (3/9, 33%) was lower compared to maturation rate after staged procedures (7/7, 100%, P = 0.011, Fisher’s exact test), which led to premature termination of the trial. Time to hemodialysis [median (interquartile range)] of primary and staged procedures was 54 (51.5–113.5) days and 97 (93–126) days, respectively (P = 0.16). One-year primary and assisted-primary patency rates of primary and staged procedures were equivalent (44 vs 57%, P = 0.76 and 44 vs 71%, P = 0.29, respectively); however, there was a trend toward a better 1-year secondary patency after staged procedures (86 vs 44% for primary procedures, P = 0.09).ConclusionsAmong candidates for TBBV fistula with a small basilic vein, staged transposition achieves higher maturation rates compared to primary procedures, a difference reflected in long-term secondary patency.Trial registration, identifier NCT01274117.

show abstract

“…Some surgeons advocate performing a second anastomosis at the second operation which potentially avoid such problems. 15 In our unit we did not want to disturb a working anastomosis and cause further scarring and therefore did not disconnect and reconnect the fistula.…”

Section: Discussionmentioning

confidence: 99%