Brachiobasilic fistula as a secondary access procedure: an alternative to a dialysis prosthetic graft

In order to extend the availability of each extremity as an access site for long-term dialysis, we created a brachiobasilic fistula by superficialization of the basilic vein, which had previously been arterialized. In this work, we present the preliminary results of this procedure.

Patients with prior forearm arteriovenous fistula dysfunction without an adequate superficial vein were enrolled in this study. The basilic vein was superficialized to create a brachiobasilic fistula. The basilic veins were transposed in 16 patients and elevated in 4 patients. At the same time, another 50 upper arm bridge prosthetic grafts were created. Finally, surgery-related complications and patency rates were analyzed and compared with upper arm prosthetic grafts.

Twenty brachiobasilic fistulas and 50 upper arm bridge prosthetic grafts were created in 70 patients in our hospital from September 2001 to January 2004. No surgery-related deaths occurred. Cannulation of the brachiobasilic fistulas began at an average of 33 (range, 21 to 84) days after surgery. All fistulas were successfully used for dialysis. The mean follow-up was 15 (range, 2 to 26) months. Moreover, the primary patency rates for the brachiobasilic fistulas and upper arm prosthetic grafts were 80% and 70%, respectively. Notably, all brachiobasilic fistulas remained patent at the last follow-up. Furthermore, surgery-related complications were 25% for brachiobasilic fistulas and 60% for upper arm prosthetic grafts. Common complications of brachiobasilic fistulas were graft thrombosis, arm swelling, hematoma formation, and steal syndrome.

Brachiobasilic fistulas are technically feasible and show excellent patency. Fewer surgery-related complications were seen compared to upper arm prosthetic grafts, and most of them were treated without loss of the fistula. We suggest that this procedure should be considered before placement of a prosthetic graft whenever feasible. These observations merely represent our preliminary experience regarding this procedure, and further investigation involving larger cases numbers is needed in the future.