Clinical outcomes of transposed brachial-basilic vein fistula: Tunneling versus elevation

Abstract

Background: The Kidney Disease Outcome Quality Initiative (KDOQI) suggests a transposed brachial basilic vein fistula (TBBVF) in the patients who have good likelihood of long-term survival. To superficialize the basilic vein, a disconnected basilic vein is anterolaterally transposed inside a subcutaneous tunnel. A simple elevation in situ is an alternative technique. The aim of this study was to compare clinical outcomes of TBBVF according to the type of superficialization. Methods: A total of 42 patients (mean age of 66 years, male: 45%) who underwent a TBBVF from April 2014 to March 2019 at our hospital were retrospectively reviewed. The method of superficialization (tunneling ( n = 18) vs elevation ( n = 24)) was determined by the surgeon’s preference. It was done as a one-stage surgery. There was not any statistically significant difference in demographic or clinical characteristics of patients between the two groups. As early outcomes, postoperative mortality and morbidity were investigated. For clinical outcomes, primary patency, primary-assisted patency, and secondary patency were analyzed for both groups. Results: There was a case of a 30-day mortality in the elevation group. Regarding morbidities, there was a postoperative bleeding in the tunneling group and a steal syndrome in the elevation group. The mean follow-up was 28 months (range, 0–63 months). There was no significant difference in primary patency (64.8% vs 77.5% in 1 year and 54.0% vs 54.1% at 3 year; p = 0.816), primary-assisted patency (88.9% vs 86.5% in 1 year and 88.9 vs 81.4 at 3 year; p = 0.624), or secondary patency (100% vs 86.5% in 1 year and 100% vs 86.5% at 3 year; p = 0.126) between the two groups. Conclusions: Clinical outcomes of TBBVF showed no significant difference between tunneling and elevation groups. Thus, TBBVF can be done with either method.