BASILIC VEIN TRANSPOSITION - AN UNDERUSED AUTOLOGOUS ALTERNATIVE TO PROSTHETIC DIALYSIS ANGIOACCESS

Purpose: Provision of lifelong angioaccess for hemodialysis generally requires multiple procedures. To extend the availability of each extre mity as an access site, we have used the transposed basilic vein for f istula construction since 1988. Our purpose is to present our initial experience, with follow-up of 30 months. Methods: We have used the tra nsposed proximal basilic vein in 65 procedures to construct an autogen ous arteriovenous fistula (AVF) to the brachial artery in 58 patients without suitable superficial venous anatomy. There were 25 males and 3 3 females, with a mean age of 47 years (range 10 to 77). The basilic v ein transposition was the initial angioaccess procedure in only 25% of cases and secondary in 75%. Three additional patients underwent explo ration of an inadequate basilic vein with subsequent prosthetic grafti ng. Results: There were no operative deaths. Two postoperative complic ations included a wound infection and a transient steal syndrome. The actuarial life-table patency rate for all successfully completed AVFs was 49% at 30 months. Late revisions with continued patency were requi red in 11 cases, including repair of a focal stenosis in six, pseudoan eurysm resection in two, and thrombectomy in one. Sixty-seven percent of patients who required subsequent prosthetic grafting for a failed b asilic vein AVF had an ipsilateral procedure. Patient preference for t he opposite arm was the usual indication for contralateral grafting in the remainder. Conclusions: The transposed basilic vein AVF was techn ically feasible in 95% of cases, can frequently be performed in patien ts with multiple previous access procedures, docs not compromise the a rm for future prosthetic grafting, and has a long-term patency rate th at is comparable to more traditional autologous AVFS. This underused p rocedure should be considered before placement of polytetrafluoroethyl ene graft for long-term angioaccess.