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Review
. 2016 Mar;25(1):14-9.
doi: 10.1055/s-0035-1558465. Epub 2015 Aug 6.

Brachial Artery-Brachial Vein Fistula for Hemodialysis: One- or Two-Stage Procedure-A Review

T Kotsis  1 , K G Moulakakis  2 , S N Mylonas  1 , P Kalogeropoulos  1 , A Dellis  1 , S Vasdekis  2
Affiliations
Review

Brachial Artery-Brachial Vein Fistula for Hemodialysis: One- or Two-Stage Procedure-A Review

T Kotsis et al. Int J Angiol. 2016 Mar.

Abstract

Purpose The purpose of the study was to investigate the patency rate of the brachial vein transposition-arteriovenous fistula [BVT-AVF] and to review the available literature regarding the comparison of the one-stage with the two-stage procedure. Methods A multiple electronic health database search was performed, aiming to identify studies on brachial vein superficialization. Case reports and series with five or less patients were excluded from the study. End points of the study were the patency rates at 12, 24, and 36 months of follow-up. The patency of the one- or two-stage BVT-AVF procedure was investigated. Results Overall, 380 BVT-AVFs were analyzed. The primary patency rate at 12 months ranged between 24 and 77%. Rate of early fistula malfunction or failure of maturation of the fistula resulting in loss of functionality ranged from 0 to 53%. Forearm edema, hematomas, wound infection, and early thrombosis were among the most common complications. Limited data were available for the comparison of patency rates between the one- and the two-stage procedure because of the absence of sufficient comparative studies. However, series with one-stage procedure presented a lower patency rate at 12 months compared to series with two stages. Conclusion Patency rates after BVT-AVF, although not excellent, has encouraging results taking into account that patients undergoing these procedures do not have an accessible superficial vein network; failure of maturation and the increased rate of early postoperative complications remain a concern. The BVT-AVF is a valuable option for creating an autologous vascular access in patients lacking adequate superficial veins.

Keywords: arteriovenous fistula; brachial vein; chronic renal failure; grafts; one-/two-stage procedure; transposition.

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Figures

Fig. 1
Fig. 1
After a period of 4 to 6 weeks of the side-to-side or the side-to-end anastomosis between the brachial vein and the brachial artery the dilated brachial vein is dissected and the tributaries are divided.
Fig. 2
Fig. 2
The matured brachial vein is superficialized in a pocket created to the subcutaneous tissue.
See this image and copyright information in PMC

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