Outcomes of relocation of basilic vein in brachiobasilic fistulas in chronic renal failure

Elevation transposition method for superficialization of the basilic vein achieves better patency rate than tunnel transposition

OBJECTIVE

To compare the tunnel transposition and elevation transposition methods used for superficialization of the basilic vein in terms of complication and patency rates.

METHODS

This retrospective study included patients who underwent two-stage basilic vein transposition between August 2016 and December 2019. Patients were categorized into brachial-basilic fistula tunnel transposition (n=32) and elevation transposition (n=21) groups using medical records. Primary patency was defined as a conduit that remains patent without any re-intervention to maintain patency. Primary assisted patency was defined as a conduit that has undergone intervention to maintain patency but has never been thrombosed.

RESULTS

The distribution of baseline characteristics was similar between the two groups. Coronary artery disease was the only variable that was significantly different between the tunnel transposition and elevation transposition groups (31.1% vs. 4.8%, p=.035). The tunnel transposition group had a greater amount of blood loss (p<.001) and a longer period of hospitalization (p=.002) than the elevation transposition group. The rates of suture repair to stop bleeding from the conduit was significantly different between the tunnel transposition and elevation transposition groups (31.8% vs. 4.8%, p=.035), whereas those of other complications were not significantly different. The elevation transposition group had a significantly higher primary patency rate than the tunneled transposition group (p=.033); however, primary assisted patency was achieved in all patients (100%) in both groups.

CONCLUSION

Elevation transposition might be a more reliable method than tunnel transposition for superficialization of a basilic venous fistula.