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The value and limitations of the arm cephalic and basilic vein for arteriovenous access

E Ascher1, A Hingoran, Y Gunduz

  • 1Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA. anilph@aol.com

Annals of Vascular Surgery
|February 28, 2001
PubMed

Insights

Arteriovenous fistulae (AVF) created using arm veins transposed to the brachial artery are a viable alternative to prosthetic grafts for hemodialysis access in end-stage renal disease patients. This study suggests brachiocephalic and brachiobasilic AVF offer good patency rates.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Dialysis Access

Background:

  • Arteriovenous grafts (AVG) and their maintenance increase costs for hemodialysis access in end-stage renal disease (ESRD) patients.
  • The National Kidney Foundation advocates for increased use of native arteriovenous fistulae (AVF).
  • While radialcephalic AVF is preferred, alternative veins are needed for an all-autogenous AVF policy.

Purpose of the Study:

  • To evaluate the experience with transposed arm veins for brachiocephalic AVF (BCAVF) and brachiobasilic AVF (BBAVF) creation.
  • To assess the patency and viability of these AVF as alternatives to prosthetic AVG.
  • To propose an algorithm for AVF placement based on clinical experience.

Main Methods:

  • Retrospective chart review, patient interviews, and dialysis record analysis for 163 patients.
  • 109 BCAVF and 63 BBAVF were placed over 2.5 years.
  • Patency assessed using life-table analysis and Kaplan-Meier survival analysis with log-rank testing.

Main Results:

  • BCAVF and BBAVF demonstrated viability as alternatives to prosthetic AVG.
  • The study included a significant number of diabetic and hypertensive patients, common comorbidities in ESRD.
  • Kaplan-Meier analysis provided patency rates for both types of AVF.

Conclusions:

  • Transposed arm vein AVF (BCAVF and BBAVF) represent a feasible option for hemodialysis access.
  • These autogenous fistulae may reduce reliance on prosthetic grafts and associated costs.
  • An algorithm for AVF selection and placement is proposed based on the study's findings.

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