Brachiobasilic AV fistula transposition without reanastomosis: preliminary results

Rocha, R; Gomes, A; Sousa, M; Germano, A; Marinho, R; Pignatelli, N; Nunes, V

http://hdl.handle.net/10400.10/1146

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Background: When the venous territory is poor the brachiobasilic arteriovenous fistulae (BBAVF) could be the only option for native vascular access. Several techniques have been proposed. Our aim is to evaluate the efficiency of the brachiobasilic AV fistula with two stage elevation and transposition without reanastomosis. Materials and Methods: Observational, descriptive and prospective study. Patients submitted to BBAVF elevation and transposition throughout 2012 and 2013 were included. A two stage procedure was done. The basilic vein was isolated, a subcutaneous flap was made and it was subsequently transposed without being transected. The subcutaneous flap is then sutured keeping the transposed vein in the anterior surface of the arm. Length of superficialized segment, distance from the skin, arterial flow, sistolic velocity, resistance index and vein diameter was measured by color doppler ultrasound. Results: From 160 patients admitted for creation of first AV access in 2012 and 2013, 22 BBAVF were performed. Average age was 65,59±12,96, 10 female patients. 18 were pre-dialysis patients. Mean follow up was 12,74 months with 13 functional access. Length of superficialized segment was always higher than 6cm (89±2,1 mm); mean distance from skin was 3,82±2,3 mm; mean arterial flow was 1,401±0,570 l/min with a max velocity of 223,16±84,02 and a resistance index of 0,48±0,17, mean vein diameter was 9,96±5,1 mm. 20 were functional as an AV access for HD at 2nd week postoperative. 3 complications were reported, 2 hematomas and 1 wound infection overcome with medical treatment. Conclusions:. This technique is safe, simpler, and efficient and allows for early use of the access. Although our follow-up is short, we are optimistic about these preliminary results and hope to compare this technique with others in the long term.