Adoption of transposed basilic vein as access for hemodialysis

Abstract

The fistula first initiative has rekindled interest in transposition of basilic vein (TBV) in preference to arteriovenous grafts (AVG). TBV is considered to have advantages over AVG. The aim of this study was to analyze the outcome of TBVs in our center comparing them to a historically matched group of patients who had AVG. Thirty-two patients who underwent TBV as a vascular access procedure in Derriford Hospital between January 2010 and October 2014 were included in the study. The historical control group comprised 31 patients who had AVG inserted in the upper arm between January 1999 and December 2010. Patients who had looped AVG were excluded from the study. The primary failure rates were 22% (7/32) and 16% (5/31) for TBV and AVG, respectively (P = 0.7500). AVGs were associated with a higher incidence of infection and steal syndrome, but the differences were not statistically significant (P = 0.286 and P = 0.286, respectively). Twenty-two interventions were undertaken in the TBV group compared to 18 in the AVG group. This study shows that adoption of TBV reduces the need for AVG. To improve TBV access maturation and survival, it is necessary to consider adopting a selection criteria based on findings on vessel mapping.