Basilic vein transposition versus biosynthetic prosthesis as vascular access for hemodialysis

Background: Vascular access (VA) complications account for a significant number of hospital admissions in dialysis and have substantial costs. A native arteriovenous fistula (AVF) cannot be successfully obtained in all patients. At our center, we established an autogenous brachial-basilic AVF (BBAVF) in the upper arm in patients with a failed forearm fistula or with superficial vessels that were unsuitable for preparing a good site for VA. In most of these patients, we resort to prosthetic materials for creating a functioning VA as the last strategy. The present study compared the outcomes of BBAVF and AV graft (AVG) in patients undergoing long-term hemodialysis in whom there was no other possibility of creating a VA.

Methods: We analyzed 57 complex patients, 27 randomized to receive AVG and 30 randomized to BBAVF, between 2002 and 2008. The Omniflow II Vascular Prosthesis (Bio Nova International Pty Ltd, North Melbourne, VIC, Australia), the latest-generation collagen-polyester composite, was used to create the prosthetic VA. Primary patency (PP) and secondary patency (SP) rates were calculated using the Kaplan-Meier test. The log-rank test was used to compare PP and SP rates of the single VA.

Results: Length of hospital admission time, total intervention time, and mean interval to the first venipuncture for dialysis were longer for BBAVF. In the early postoperative period, patients who received BBAVF had a complication rate similar to those who received AVG; however, patients who received AVG showed a higher rate of long-term adverse events. PP and SP rates were higher for BBAVF than for AVG, although this was not statistically significant for SP.

Conclusions: Our results show that BBAVF should be the first choice in patients with a good life expectancy and who can rely on an available temporary VA. However, given the shorter time to use, AVG could be an alternative in patients with compromised clinical conditions and in whom a temporary VA is not reliable, considering that the long-term outcome may be considered beneficial regardless.