UPPER ARM BASILIC VEIN TRANSPOSITION FOR HEMODIALYSIS: WHAT IS THE OPTIMAL TECHNIQUE?

Objective: The brachiobasilic arteriovenous fistula (BBAVF) can be formed in one or two stages. This study examined the failure rates and functional patencies of one-stage vs two-stage brachiobasilic transposition fistulas to compare the two surgical techniques.
Patients and methods: 50 BB fistulae (25 single and 25 two-stage) were created over a 3year period (2012-2015). Data including sex, age, dialysis and diabetic status was collected from the case notes. Patency and time to maturity data was collected prospectively from the dialysis unit.
Results: During the study interval, 100 brachiobasilic transpositions (50 one-stage and 50 two-stage) were performed in 100 patients. Patients undergoing the two-stage procedure tended to be older (mean 49 vs 53 years; P = 0.8). The two-stage BBAVFs had significantly better primary (88% vs 92%; P=0.58), and secondary functional (92% vs 96%; P=0.508.) patencies. Pre-HD fistula has better patency than post-HD fistula (100% vs 90%; p=0.015)
Conclusion: This study describes a series of BBAVFs and makes comparison between the one-stage and two-stage operations. Significantly improved overall functional patency is demonstrated for the two-stage operation.