Saphenous Vein or Basilic Vein Transposition in Hemodialysis Patients?

OBJECTIVE: Secondary arteriovenous fi stula (AVF) management with saphenous vein (SV) graft and basilic vein transposition (BVT) in HD-dependent patients are good alternatives. A concurrent series of patients was reviewed to evaluate the patency and complication rates after AVF formation.

MATERIAL and METHODS: From January 2006 to January 2010, 40 secondary HD access procedures were performed in 40 consecutive patients. All access procedures were planned on the basis of preoperative duplex ultrasonography (USG) scans of arm and forearm veins. Functional patency was defi ned as the ability to cannulate the patient for HD successfully. Primary and secondary cumulative functional patency of SV grafts and BVT’s were determined with the Kaplan Meier test, differences were analyzed with Log Rank test, and differences in revision rates including thrombolysis thrombectomies and operative revisions were analyzed with the Z test and the Fisher exact T test.

RESULTS: Mean follow up was 48 months (range 43-54 months). Risk factors were similar between the two groups. SV group and BVT group had similar patency ratings. The HD access complication rates were higher in the SV group.

CONCLUSION: Our data strongly support the notion that the BVT must always be considered before an SV graft as long as the patient is a candidate for an upper arm secondary AVF creation based on anatomical criteria.