Relationship of preoperative venous and arterial imaging findings to outcomes of brachio-basilic transposition fistulae for hemodialysis: a prospective clinical study.

Abstract

To evaluate the maturation and patency of transposed brachio-basilic fistulae that had been chosen based on the results of preoperative imaging techniques. Among 215 patients admitted to our clinic requiring arteriovenous fistulae between May 2004 and September 2005, 59 were scheduled for a transposed brachio-basilic fistula procedure. The relationship between demographic data, laboratory values, invasive and noninvasive imaging studies with patency and maturation time of the fistulae were evaluated by univariate analyses. Primary and secondary patency rates were 82% and 97% at 6 months 72% and 92% at one year respectively. The only parameter found to affect maturation time was basilic vein diameter. The maturation time was 59.3+/-22.3 days (range 32-92 days) for veins less than 3mm in diameter and 24.7+/-4.4 days (range, 21 to 34 days) for those with larger diameters. The number of previously failed fistulae correlated with a decrease in primary patency time. The primary patency rate at 1 year was 58.9% for patients whose preoperative arterial flow rate was below 70cm/sec, while it was 93.3% when the flow was greater. We believe that this type of fistula should be the first option in patients in whom the cephalic vein is inappropriate for a vascular access. Preoperative evaluation of the arterial system as well as a history of previous access failure may be considered predictive parameters for the patency of the fistulae.