Two‐Stage Basilic Vein Transposition: Second Stage Results

Abstract

The increasing survival of hemodialysis patients results in the depletion of superficial venous capital justifying the use of the basilic vein. Many groups still prefer an arteriovenous graft due to transposition complexity and the time needed to achieve maturation. In this work we review the results of our series of basilic vein transpositions (BVT). BVTs were performed in two stages: first, creation of the fistula; second, transposition of the vein using three small incisions in the arm. All patients had to have direct arterialization of the basilic vein, therefore, patients with previous ipsilateral wrist fistulas also followed a two-stage protocol. Data were retrospectively revised from all transposition procedures made between September 2005 and November 2012. Patency and complication rates were the primary outcomes evaluated. A total of 276 basilic veins were transposed. Usage rate was 82.2%. 8% (N = 22) of the fistulas were never used due to thrombosis. Secondary patency rates at 1 and 2 years were, respectively, 84% and 66.3%. Complications occurred in 61.6% (N = 170) of fistulas and 65.9% (N = 112) of which had to undergo surgical or endovascular revision. The most frequent complication was vein stenosis (39.7% of late complications, N = 92). Albeit its greater technical complexity, the transposed basilic vein represents a hemodialysis access with good patency rates. Complication rates, although high, are less than those of CVC or prosthetic grafts. These results support the use of the transposed basilic vein as hemodialysis access after the brachiocephalic fistula.

Postoperative Ultrasound, Unassisted Maturation, and Subsequent Primary Patency of Arteriovenous Fistulas

“…If an AVF was deemed too deep for cannulation on postoperative ultrasound or physical examination, it underwent surgical transposition (superficialization). For the purpose of study analysis, standalone surgical transposition of an AVF (without a concurrent surgical intervention such as revision of the anastomosis) was considered to be a procedure to facilitate cannulation rather than an intervention to assist AVF maturation (17,18).…”

One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art

“…19 Aneurysmal dilatation was a complication reported exclusively in three of the single studies, all treated with ligation. 20–22 Steal syndrome, variously described, occurred in 1%–4% 17,18 of patients in staged studies and 1%–11% 2,22–24 in single-stage surgery, although Rego et al reported “late steal syndrome” in 65.2% of staged patients. Many of the current studies failed to report incidence of venous stenosis, exact location, and/or significance of the stenosis.…”

“…Wound infection was present in between 3.4% and 17% of patients undergoing single-stage BBTx and between 0% and 19% of those undergoing two-stage BBTx, but only described in two 15,16 and five such studies, 14–18 respectively. One case of ulnar neuropathy occurred in a staged patient.…”

“…These are studies that focused on one of the two options. 2,5–7,14–17,20–36 The largest single-stage studies are Korkut (N = 375) and Glass (N = 217), while the largest two-stage study is Rego (N = 276). Korkut and Kosem achieved a maturation rate of 93% with 1-year primary and secondary patency rates of 92% and 93%, respectively, while Glass et al reported a maturation rate of 87%.…”

One-stage basilic vein tunneled transposition for hemodialysis access

“…Therefore, BV AVF remains an access option for difficult cases, along with central venous catheter placement or prosthetic graft AVF [2]. BVTT is technically more complex than catheter placement or prosthetic graft AVF [5,9], but has all the advantages of autogenous AVF and forms a long and superficial vein segment suitable for cannulation [7].…”