NDT Advance Access originally published online on July 19, 2005
Nephrology Dialysis Transplantation 2005 20(10):2168-2171; doi:10.1093/ndt/gfh997
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Excellent performance of one-stage brachial–basilic arteriovenous fistula
1 Department of Surgery, 2 Department of Nephrology, 3 Department of Clinical Epidemiology and 4 Department of Radiology, University Hospital Maastricht and 5 Department of Biophysics, 6 Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, The Netherlands
Correspondence and offprint requests to: Xavier H. A. Keuter, Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: xha.keuter{at}ah.unimaas.nl
Background. According to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) and the European Guidelines, the first and second choice for vascular access for haemodialysis are the radial–cephalic and brachial–cephalic arteriovenous fistula (AVF). Autogenous fistulas have a longer functional lifetime, less thrombotic complications and a lower infection risk compared with prosthetic implants. If it is impossible to create a brachial–cephalic AVF or after failure, either a brachial–basilic (BB) or a prosthetic forearm loop AVF may be considered. To determine the outcome of BB-AVFs, we retrospectively surveyed the results of this type of vascular access.
Methods. All BB-AVF patient records over a 6 year period were subtracted from an academic hospital registry. Primary failure and primary, assisted primary and secondary patency rates were calculated with the Kaplan–Meier method. Sex, diabetes mellitus (DM), pre-operative duplex diameters, complications and interventions were recorded and correlated with the patency rates.
Results. A total of 31 BB-AVFs were created in a one-stage surgical procedure. Of the patients, 36% were male and 19% had DM. Only one patient had a primary failure, leaving 30 (97%) of the BB-AVFs functional for dialysis treatment. Four patients died within 1 year after the operation, one of them from a catheter sepsis. Primary, assisted primary and secondary patency rates after 1 year were, 58, 83 and 90%, respectively. Patient characteristics and pre-operative duplex parameters did not influence patency rates.
Conclusion. The BB-AVF is an excellent third choice option for vascular access.
Keywords: brachial–basilic arteriovenous fistula; haemodialysis; retrospective study; vascular access patency