Basilic Vein Transposition Used as a Tertiary Vascular Access for Hemodialysis: 15 Years of Experience.

Introduction: The quality of the life in patients requiring long term hemodialysis is directly proportional to the long-term patency of their vascular access. Basilic vein transposition for vascular access (BAVA) represents a suitable option for creating a tertiary native vascular access for hemodialysis on the upper extremities for patients requiring long term hemodialysis. The purpose of the study is to compare BAVAs with arteriovenous grafts (AVG).

Method: Data collection was based on selecting all of the patients with BAVA created in the time period in between January 1996 and August 2011. A questionnaire was created and sent to the selected hemodialysis centers. The resulting set of data was statistically analyzed and evaluated.

Results: In the time period between 1 January 1996 and August 2011, arteriovenous access for hemodialysis was created in 6754 patients (7203 procedures in total). Out of these patients, 175 BAVAs were created. Our patient database of those undergoing the BAVA procedure consisted of 98 females (56%) and 77 males (44%) with an average age of 64.5 years. The prevalence of diabetes mellitus was 60% (105 patients). Primary patency after 12 months was 68.8%, 24 months 59.7%, 36 months 53.8, 48 months 53.8%, and 60 months 50%. Primary assisted patency after 12 months was 89.9%, 24 months 84.6%, 36 months 77.8%, 48 months 77.9%, 60 months 70.8%. Secondary patency after 12 months was 89.4%, 24 months 86.9%, 36 months 81%, 48 months 78.9%, 60 months 75.7%. Twenty-nine BAVAs (16.5%) were obliterated.

Conclusion: Patients benefit from this type of procedure due to the longer patency of a native arteriovenous access, as well as a lower incidence of infectious complications.