Two-stage brachiobasilic arteriovenous fistula for chronic haemodialysis access.

Abstract:

BACKGROUND:Many haemodialysis patients are unable to have or maintain distal upper limb arteriovenous (AV) fistulas because of inadequate veins or arteries and therefore require more proximal access. We have reviewed our experience with a two-stage brachiobasilic AV haemodialysis fistula fashioned in the arm. METHODS:Ninety-one brachiobasilic AV fistulas were fashioned in 87 patients between August 1999 and October 2004. Four AV fistulas failed because of early thrombosis. The second stage 'superficialization' was carried out at a median (range) of 73 days (32-1827 days) after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the anteromedial aspect of the arm and transposing it beneath the skin incision. RESULTS:Primary and secondary patency rates were 87 and 89%, respectively, at 1 year and 78 and 84%, respectively, at 2 years. Early complications included infection (3%) and haemorrhage (4%) and late complications included thrombosis (15%) and stenosis (14%). CONCLUSION:The two-stage superficialized brachiobasilic AV fistula described in this article has good patency. The operative techniques are straightforward, have relatively low complication rates and result in a large-diameter fistula on the anteromedial aspect of the arm allowing easy and painless cannulation for haemodialysis.

journal_name

ANZ J Surg

journal_title

ANZ journal of surgery

authors

Francis DM,Lu Y,Robertson AJ,Millar RJ,Amy J

doi

10.1111/j.1445-2197.2006.03996.x

subject

Has Abstract

pub_date

2007-03-01 00:00:00

pages

150-5

issue

3

eissn

1445-1433

issn

1445-2197

pii

ANS3996

journal_volume

77

pub_type

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