One-Year Functional Patency and Comparison of Superficialization Techniques for Brachiobasilic Arteriovenous Fistulas

Superficialization of brachiobasilic arteriovenous fistulae (BBAVFs) is generally performed by either creating a shelf or dividing, tunneling, and transposing the vein with reanastomosis. This multiinstitutional study evaluates the impact of these techniques and other variables on BBAVF functional patency at 12 months.

A retrospective review of patients who underwent two-stage BBAVF between 2014 and 2019 with at least 1-year follow-up was conducted from 5 safety net hospitals. The primary end point was functional patency at 12 months. Bivariate and multivariate logistic regression models evaluated the relationship between preoperative and intraoperative variables and fistula function at 12 months.

There were 260 patients with an overall 12-month functional patency rate of 71.5%. Use of aspirin (odds ratio [OR] 1.858, 95% confidence interval [CI] 1.023-3.372, P = 0.042) and intraoperative anticoagulation (OR 2.118, 95% CI 1.193-3.760, P = 0.01) at the first stage procedure, and previous arteriovenous fistula or graft (OR 0.465, 95% CI 0.233-0.928, P = 0.030), were associated with functional patency at 12 months. When comparing shelfing versus transposition techniques, there was no significant difference in the functional patency rates (83.6% vs. 89.9%, P = 0.179), although the shelfing technique was associated with a higher rate of postoperative complications (19.8% vs. 9.0%, P = 0.027).

In patients undergoing 2-stage BBAVF, the use of aspirin and intraoperative heparin at the first stage procedure are associated with higher functional patency at 12 months. Functional patency was similar for the shelfing technique versus transposition at the second stage. The shelfing technique was associated with higher rates of postoperative complications, primarily related to wound healing.