Purpose: To evaluate the basilic vein transposition into the volar aspect of the forearm and anastomosis with the distal radial artery, as a native vein for the construction of arteriovenous fistulas before shifting to the use of upper arm basilic vein or arteriovenous prosthetic graft .
Methods: From January 2008 to December 2010, 75 patients who underwent AV access for hemodialysis in Zagazig University hospitals were retrospectively reviewed with following up the patients in the dialysis centers and the current AVF functions were evaluated in the outpatient clinic. Patients were grouped by the operation type into radiocephalic fistulas (RCF) in the forearm (above the wrist or mid forearm),forearm loop arteriovenous graft (FAVG) and forearm basilic vein transposition (FBVT). The outcomes compared were primary, secondary patency rates, maturation failure, and early or late complications.
Results: 49 patients (65.3%) were males, 57 patients (76%) were diabetics, and 38 patients (50.6%) had previous access surgery. In 29 patients (38.6%) the cephalic vein was used as outflow vein, in 14 patients (18.6%) brachial vein was used as outflow for FAVG, in 7 (9.3%) patients midcubital vein was used as outflow for FAVG and in 25 patients (33.3%) the forearm basilic vein was transposed and used as outflow vein after anastomoses with the radial artery. Overall complications occurred in 36 (48%) patients over the follow up period and included hematoma (n=2), thrombosis (n=19), infection (n=9), ischaemic steal syndrome (n=3) and venous hypertension (n=3). Meanfollow-up was 15 months (range, 3-24 months). Maturation failure occurred in 3 radiocephalic fistula patients and in 4 FBVT patients.The primary patency rates for RCF, FBVT, and FAVG were 68.9%, 52%, and 42.8% at 12 months respectively.
Conclusion: Whenever the presence of adequate forearm basilic vein with a suitable caliber, forearm basilic vein transposition is a good alternative autogenous option to be considered before forming an upper arm AVF or forearm AVG.