Brachial versus basilic vein dialysis fistulas: a comparison of maturation and patency rates

Abstract

Objectives: Although the performance of basilic vein transpositions for dialysis access is well established, the utility and patency rates of brachial vein transpositions are poorly characterized. The brachial vein is being used increasingly as an alternative vein for transposition in an effort to increase the percentage of autogenous fistula utilization. The purpose of this study was to review a single-center comparative experience with these fistulas.

Methods: A retrospective chart review was performed on 59 patients who received basilic and brachial vein transpositions between January 2000 and December 2006. Patient demographics, comorbidities, mortality, and morbidity were evaluated. Patency rates were calculated using Kaplan-Meier life-table analysis.

Results: Of 59 vein transpositions, there were 42 basilic (71%) and 17 brachial (29%). The 30-day mortality was 0%. Maturation rates were 74% for basilic vein transpositions and 47% for brachial (P = .049). The mean time to maturation was 11.9 +/- 8.8 weeks. Primary patency rates at 12 months were 50% for basilic vein transpositions vs 40% for brachial (P = .115). The mean vein size was 4.9 +/- 0.9 mm. The mean basilic vein transposition diameter of 4.9 +/- 1.0 mm and brachial vein transposition diameter of 5.0 +/- 0.8 mm were not significant (P = .39).

Conclusions: Despite a higher rate of initial maturation in basilic vein transpositions, brachial and basilic vein transpositions had comparable patency rates at 12 months. These preliminary results require further follow-up and a larger cohort of patients for confirmation. Broader use of the brachial vein transposition for dialysis appears justified and can increase the overall percentage of autogenous fistula placement.