Document Detail


Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula.
MedLine Citation:
PMID:  20080009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Since the publication of Dialysis Outcomes Quality Initiative (DOQI) guidelines, the use of native veins for the construction of arteriovenous fistulas (AVF) for hemodialysis has been highly recommended rather than prosthetic arteriovenous grafts (AVG). Upper arm basilic vein transposition (BVT) has been accepted widely, with superior patency compared with AVG, but only a few studies have reported outcomes of forearm BVT (FBVT). This study evaluated the efficacy of FBVT compared with direct AVF (DAVF) and AVG in a tertiary referral center.
METHODS: From January 2005 to December 2007, 461 patients underwent AV access for hemodialysis in Seoul National University Hospital. We retrospectively reviewed the medical records and dialysis sheets and evaluated the current AVF function in the outpatient clinic or by telephone interviews. Patients were grouped by the operation type: DAVF, FBVT, and AVG. The outcomes compared were primary, assisted-primary and secondary patency rates, maturation failure, and complications.
RESULT: The mean age was 59 years (range, 14-92 years), and 280 patients (60.7%) were male. By operation type, the 461 accesses were 389 DAVF (84.4%), 34 FBVT (7.4%), and 38 AVG (8.2%). Mean follow-up duration was 21 months (range, 1-51 months). The primary patency rates for DAVF, FBVT, and AVG were 67.6%, 41.5%, 35% at 12 months and 53.9%, 30.2%, 10.3% at 24 months, respectively. The secondary patency rates were 89.2%, 79.1%, 78.3% at 12 months and 83.8%, 74.4%, 64.9% at 24 months, respectively. Maturation failure occurred in five DAVF patients and in one FBVT patient. The infection rate was 0.3% in DAVF and 12.5% in AVG, but no infection occurred in patients with FBVT. Multivariate analysis revealed that age and history of previous access were associated with lower primary patency.
CONCLUSION: Forearm BVT showed an acceptable, high 2-year patency rate and fewer thromboses and infectious complications than AVG. Forearm BVT could be considered before forming an upper arm AVF or forearm AVG, if the basilic vein is available.
Authors:
Hae-Jung Son; Seung-Kee Min; Sang-Il Min; Yang Jin Park; Jongwon Ha; Sang Joon Kim
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article     Date:  2010-01-15
Journal Detail:
Title:  Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-08     Completed Date:  2010-04-13     Revised Date:  2011-03-16    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  667-72     Citation Subset:  IM    
Affiliation:
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arteriovenous Shunt, Surgical* / adverse effects
Female
Forearm / blood supply*
Graft Occlusion, Vascular / etiology
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Renal Dialysis*
Republic of Korea
Retrospective Studies
Risk Assessment
Risk Factors
Surgical Wound Infection / etiology
Thrombosis / etiology
Time Factors
Treatment Outcome
Vascular Patency
Veins / surgery
Young Adult
Comments/Corrections
Comment In:
J Vasc Nurs. 2011 Mar;29(1):64-5   [PMID:  21315293 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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