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Staged basilic vein transposition for dialysis angioaccess
1Surgery Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.
Background:
To find out a suitable procedure to dissect an arterialised thick walled vein to create secondary angioaccess for dialysis. Delicacy of the vein wall, high rate of thrombosis and difficulty to find out a suitable vein are the main obstacles to vascular surgeons during the creation of secondary angioaccess.
Methods:
Forty patients in need for secondary angioaccess for dialysis were admitted for basilic vein transposition. They were classified randomly into two equal groups matched for age and sex. Group A patients were submitted to traditional basilic vein transposition. In group B, the operation was done in two stages. In the first stage, brachiobasilic anastomosis was done. Two to four weeks later the second stage was done to 19 patients (one patient had occluded shunt before the second stage) in the form of superficialization of the vein to be placed in the subcutaneous tissue.
Results:
Follow-up period for 6-24 months revealed that in the early postoperative period (4 weeks after operation) patency rate was 12/20 (60%) in group A and 18/20 (90%) with significant difference (p<0.05) between the two groups. Later, occlusion occurred in two patients in each group. At the end of the study the overall patency was 10/20 (50%) and 16/20 (80%) in group A and B respectively with significant difference between them. Both groups were similar in minor complications.
Conclusions:
The staged basilic vein transposition is superior to the traditional operation in the patency rate and is recommended as a safe operation for a successful secondary angioaccess.