Outcomes after ulnar-basilic arteriovenous fistula formation

The ulnar-basilic arteriovenous fistula (UBAVF) is rarely used owing to perceived problems with poor patency and prolonged maturation times. We report outcomes after UBAVF formation.

Patients who had a forearm UBAVF formed between October 1, 2002 and September 31, 2010 were identified from a prospectively maintained database.

Fifty-two UBAVFs were formed in 48 patients. The majority were male (77.1%), with a median (range) age of 69.5 (18-86) years. Primary and secondary patencies at 1, 3, and 5 years were 43%, 13%, 13%, and 54%, 18%, and 13%, respectively. Primary patencies were higher in those with previously functioning radiocephalic arteriovenous fistulas on the same arm (P = 0.03). Thirty-six percent of UBAVFs became functional, with a median (range) time to maturation of 100 (32-471) days. Nine UBAVFs (17.3%) required revision surgery. Complications were rare (7.7%), with only one case of steal syndrome.

Although UBAVF patency and functionality rates are low, we believe that these are acceptable, given the low risk of complications and preservation of precious upper-arm venous capital. Maturation can be prolonged, but when the forearm cephalic vein is unusable, UBAVFs can provide an alternative to upper-arm fistulas, and should be utilized more widely, especially in those with previously functioning ipsilateral radiocephalic arteriovenous fistulas.