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Basilic vein transposition: what is the optimal technique?

S K Kakkos¹, G K Haddad, M R Weaver

¹Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, K-8, 2799 W Grand Boulevard, Detroit, MI 48202, USA.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery

|February 23, 2010

Summary

The two-stage basilic vein transposition (BVT) fistula technique shows lower complication rates than the one-stage method. However, the one-stage BVT fistula allows for faster access use, though maturation rates are similar.

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Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency

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Area of Science:

Vascular Surgery
Dialysis Access
Surgical Techniques

Background:

Basilic vein transposition (BVT) fistula is a common procedure for hemodialysis access.
Optimizing BVT fistula techniques is crucial for patient outcomes and access longevity.

Purpose of the Study:

To compare the morbidity and maturation rates of a one-stage BVT fistula with a modified two-stage technique.
To evaluate the efficacy and safety of different BVT fistula surgical approaches.

Main Methods:

Retrospective case-controlled study involving 173 patients undergoing BVT fistula creation.
Comparison of one-stage BVT (single incision) versus two-stage BVT (two skip incisions) procedures.
Outcome measures included morbidity (venous hypertension, hematomas, complications) and fistula maturation rates.

Main Results:

The two-stage BVT technique demonstrated significantly lower rates of venous hypertension (4% vs. 17%), wound hematomas (3% vs. 13%), and overall complications (11% vs. 43%) compared to the one-stage approach.
Time to fistula use was significantly shorter for the one-stage BVT (68 days) versus the two-stage BVT (132 days).
Failure to mature rates were comparable between the two techniques (15% vs. 18%).

Conclusions:

The two-stage BVT fistula technique is associated with reduced morbidity compared to the one-stage procedure.
The one-stage BVT fistula offers faster access to use but with higher complication risks.
An individualized approach is recommended, and further research is needed to definitively establish the superiority of either technique.