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Improved Outcome With Two-Stage Basilic Vein Transposition Compared to One Stage Procedures: Results From a Case-Controlled Study.

OBJECTIVES: Previous studies have suggested that two-stage basilic vein transposition (BVT) might be superior to one-stage procedures. The aim of the present study is to compare procedure outcome of the traditional BVT with a modified two-stage technique.
METHODS: One hundred and twelve patients underwent BVT, as one-stage procedure (n=56) or a two-stage procedure (n=56). Baseline demographics were comparable. In one stage procedures the basilic vein was mobilized through a single incision, placed inside an anterolateral arm tunnel, followed by arterial anastomosis with the brachial or proximal radial vein. During the first stage of BVT we created only the fistula-arterial anastomosis, while the second stage included mobilization of the basilic vein through two small incisions (Figure), transection near the anastomosis, placement inside an anterolateral arm tunnel and reanastomosis.
RESULTS: General anesthesia was used more often in one stage BVT (14%), compared to the two stage procedures (4%, p=0.047). In one stage BVT the incidence of venous hypertension, postoperative bleeding and all complications (16%, 14% and 39%, respectively) was significantly increased compared to the two stage BVT procedures (2%, p=0.008, 4%, p=0.047 and 13%, p=0.001, respectively). There was no difference in the incidence of steal syndrome between the two methods (5% in both groups, p=1.00) or failure to mature rate (9% and 5%, respectively, p=0.46).
CONCLUSIONS:Our results indicate that a two-stage BVT through two small arm incisions is superior to the traditional one stage procedure. Long-term follow-up to compare the patency rates of these two methods is necessary.