Endoscopic basilic vein transposition for hemodialysis access

Area of Science:

• Vascular Surgery
• Nephrology
• Minimally Invasive Procedures

Background:

• Autogenous arteriovenous fistulas (AVFs) are preferred for hemodialysis access due to better outcomes.
• Deep vein transposition (open/AVF-T) is necessary for patients lacking superficial veins, but involves long incisions and healing times.
• Minimally invasive endoscopic AVF transposition (endo/AVF-T) aims to reduce recovery time.

Purpose of the Study:

• To evaluate the efficacy and outcomes of endoscopic AVF transposition (endo/AVF-T).
• To compare endo/AVF-T with traditional open AVF transposition (open/AVF-T).

Main Methods:

• Retrospective review of a vascular access database.
• Analysis of 98 technically successful endo/AVF-Ts and comparison with 78 preceding open/AVF-Ts.
• Evaluation of demographics, time to access use, and patency rates (primary, assisted, cumulative).

Main Results:

• Mean time to access use was significantly shorter for endo/AVF-T (6 weeks primary, 12 weeks staged) vs. open/AVF-T (8 weeks primary, 16 weeks staged).
• 12- and 24-month cumulative patency rates were comparable: 95.5% and 88.6% for endo/AVF-T, versus 96.0% and 88.9% for open/AVF-T.
• No significant differences in primary, assisted, or cumulative patency between the two techniques.

Conclusions:

• Endoscopic AVF-T significantly reduces the time to access use for hemodialysis.
• Endoscopic AVF-T demonstrates equivalent patency rates to open AVF-T.
• Endoscopic AVF-T is a viable and effective alternative to traditional open transposition for creating autogenous arteriovenous fistulas.