Evaluation of the Efficacy of the Single Stage Brachio-Basilic Transposition Fistula

Introduction: In keeping with established international guidelines our institute follows an “all-autogenous” approach with regard to hemodialysis access. Upper arm transposition fistulas can allow for access options when forearm autogenous options are not suitable. We evaluate our experience with a single staged brachio-basilic arteriovenous fistulas (BBAVF) to assess efficacy and patency. Methods: We retrospectively reviewed all patients who underwent a BBAVF formation from January 2005 to December 2011. Results: 30 fistulas were created on 30 patients.Median age is 50 years old, 16 (53%) patients are male. Renal failure was associated with diabetes in 11 (37%) patients and 22 (73%) patients were already receiving hemodialysis prior to fistula formation. For eight (26%) patients BBAVF was the first attempt at upper extremity access. Median basilic vein diameter was 4.5 mm (range of 2.86.7 mm). Median length of follow up was 15 months. Primary patency rates at 6 months, 1 year, and 2 year were 79%, 65 %, and 59 % respectively. Primary assisted patency rates were 86%, 81 %, 67% and secondary patency rates were 93%, 93%, 93 % respectively. No patients went on to have a prosthetic graft placement. A total of 20 secondary procedures were required to maintain patency, 15 surgical revisions were performed on 9 patients and 5 endovascular procedures on 3 patients. Discussion: In our experience a single stage BBAVF provides an excellent option for maintaining autogenous hemodialysis access with good long term patency.