Basilic vein transposition for unsuitable upper arm hemodialysis needle access segment may attenuate concurrent hand...

Some hemodialysis patients with a brachial arteriovenous fistula (AVF) have an unsuitable upper arm needle access segment (NAS) necessitating basilic vein transposition (BVT). It was frequently observed that a portion of these patients spontaneously experienced a warmer and less painful dialysis hand after BVT. Aim of this study was to determine whether BVT for an inadequate NAS attenuated hemodialysis access-induced distal ischemia in patients with a brachial AVF.

Patients with a brachial AVF and an unsuitable NAS also reporting hand ischemia and scheduled to undergo BVT between 2005 and 2016 in a single facility were studied. Hand ischemia was graded as proposed in a 2016 consensus meeting. Hand ischemic questionnaire (HIQ-) scores (0 points, no ischemia-500 points, maximal ischemia), digital brachial index (DBI, ischemia <0.6) and access flow (mL/min) before and after BVT were compared. The cephalic vein and all side branches of the basilic vein were ligated during the BVT.

Ten patients were studied (8 males, 61 [54-75] years). BVT was performed 8 [4-10] months following the initial AVF construction. HIQ-scores dropped from 220 [71-285] to 9 [0-78] (P = 0.043) postoperatively, whereas DBI increased from 0.51 [0.39-0.67] to 0.85 [0.68-0.97] (P = 0.012). DBI and HIQ-scores were inversely correlated (R² =71%, P = 0.001). Access flows dropped significantly (Flow_pre 1120 mL/min [1100-2300] vs. Flow_post 700 mL/min [600-1760]; P = 0.018). Surgery-associated complications were absent and dialysis continued uninterruptedly. Eight patients reported total recovery from hand ischemia six weeks postoperatively.

Basilic vein transposition for an unsuitable upper arm needle access segment may attenuate hand ischemia in patients with a brachial AVF previously reporting hemodialysis access-induced distal ischemia.