Introduction
Brachiobasilic arteriovenous fistula (AVF) represents one of the most important accesses for hemodialysis; however, its transposition requires a long incision and extensive surgical dissection. In this study, we aimed to minimize the extent of surgery by using only keyhole incisions depending on a catheter-based technique.
Patients and methods
This work was designed as a single-center prospective study that included 30 patients indicated for brachiobasilic arteriovenous access. After exposure and dissection of the basilic vein at the elbow, a 0.035 hydrophilic guidewire was introduced into basilic vein up to superior vena cava followed by a 6-Fr straight guiding catheter after fixing its tip to the basilic vein’s transected end. The catheter was introduced gently inverting the basilic vein till a resistance was faced, representing a side branch, and a keyhole incision was performed to divide this branch. The basilic vein is then mobilized from an axillary incision and transposed in an anterolateral tunnel to be anastomosed with the brachial artery.
Results
Between April 2019 and April 2020 with follow-up to December 2020, 30 patients underwent the procedure. The mean operative time was 87.60±9.91 min, with primary patency of 86.7% and secondary patency of 93.3%. Life table analysis showed that brachiobasilic AVF created with basilic veins more than or equal to 4 mm had a higher primary patency than that created with veins less than 4 mm in diameter. Impairment of primary patency was significantly associated with increased age (=0.022), diabetes mellitus (=0.035), and patients on anticoagulant therapy (=0.004). Two (6.7%) patients developed arm edemas, five (16.7%) patients had postoperative hematomas, three (10.0%) patients experienced infections, and no patient developed pseudoaneurysm, arterial steal, or nerve injuries.
Conclusion
Construction of arteriovenous fistulae using keyhole incisions and inversion of the vein over a wire provides a feasible technique with minimal complications and improved cosmetic outcomes.