Brachial Vs Basilic Vein Transposition Dialysis Fistulas -- Are Their Patency Rates Comparable?

Objectives: While the performance of basilic vein transpositions (BVT) for dialysis access is well known, the utility and patency rates of brachial vein transpositions (BrVT) are poorly characterized. The brachial vein is being used increasingly as an alternative vein for transposition in an effort to increase the percentage of autogenous fistula utilization. The purpose of this study was to review a single center comparative experience with these fistulas.
Methods: A retrospective chart review was performed on 42 patients who recieved BVT and BrVT from 1/2000-12/2005. Patient demographics, comorbidities, mortality, and morbidity were evaluated. Patency rates were calculated using Kaplan-Meier life table analysis.
Results: We created 42 fistula transpositions, 32 (76%) BVT and 10 (24%) BrVT. Patient demographics included 57% males, 43% females; 57% African Americans, 43% whites, 5% latinos; 48% had diabetes; 95% had hypertension. The mean vein size was 4.7 mm.
Our thirty-day mortality was 0%. The maturation rate was 62%. The mean time to maturation was 13 weeks. Six-month primary patency rates of BVT (44%) and BrVT (46%) were not significantly different (p=0.45). Twelve-month primary patency rate of BVT was 40%. There were an inadequate number of BrVT at twelve months to calculate patency rates.
Conclusions: Brachial and basilic vein transpositions appear to have similar patency rates at six months. These preliminary results require further follow-up and a larger cohort of patients for confirmation. Broader utilization of the brachial vein for transposition dialysis fistula appears justified and can increase the overall percentage of autogenous fistula placement.