A retrospective review of basilic and cephalic vein-based fistulas

This study compares outcomes of basilic and cephalic vein fistulas for hemodialysis. A retrospective review of arteriovenous fistulas in a university hospital system was performed using charts and hemodialysis records. Patency and demographic data were assessed with life table analysis. One hundred fifty-six patients (88 males; 68 females) underwent creation of 172 autogenous fistulas (mean age 61 years; mean follow-up 78 weeks). There were 101 basilic vein transpositions and 71 cephalic vein fistulas. Primary patency did not differ significantly, while assisted primary patency was significantly better for basilic vein fistulas at one year (73% versus 53%: P = 0.024). Secondary patency was significantly better for basilic fistulas through three years (58% versus 52%; P = 0.027). Primary failure (thrombosis before access or failed maturation) was significantly higher for cephalic than basilic fistulas (28% versus 13%; P = 0.01). Maturation time, usage time and complications were not significantly significant. Thirty-three (33%) basilic vein-based fistulas and 12 (17%) cephalic vein fistulas required revision during follow-up. Basilic vein-based fistulas perform as well as or better than cephalic vein-based fistulas in terms of patency, maturation time, and usage time and complication rates, though requiring more re-interventions.

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Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420969252 ◽

2020 ◽

pp. 153857442096925

Author(s):

Chen-Ting Cheng ◽

Yuan-Chen Chang ◽

Ka-Wai Tam ◽

Yu-Chun Yen ◽

Yu-Chen Ko

Keyword(s):

Retrospective Study ◽

Hemodialysis Patients ◽

Primary Patency ◽

Secondary Patency ◽

Arteriovenous Graft ◽

Basilic Vein ◽

Arteriovenous Access ◽

Secondary Outcomes

Background: Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. Methods: A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. Results: Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). Conclusion: Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.

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P1339ARTERIOVENOUS FISTULA AND BASILIC VEIN TRANSPOSITION IN ELDERLY PATIENTS ON HEMODIALYSIS: AN OBSERVATIONAL STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1339 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vinant Bhargava ◽

Priti Meena ◽

Ambrish Satwik ◽

Apurv Srivastava ◽

A K Bhalla ◽

...

Keyword(s):

Elderly Patients ◽

Vascular Access ◽

Elderly Population ◽

The Elderly ◽

Primary Patency ◽

New Delhi ◽

Secondary Patency ◽

Basilic Vein ◽

The Mean

Abstract Background and Aims With the increase in the line expectancy of chronic kidney disease in the older population (>60 years), the numbers requiring haemodialysis is progressively rising. The elderly population may be different from the younger in terms of non-suitable vessels for access creation, non-maturation, and vascular calcifications, and this may alter the outcomes of use of arteriovenous fistula (AVF). This study was conducted to analyse the outcomes of AVF in elderly patients (>60 years). Method Retrospective study was conducted in the Department of Nephrology at Sir Ganga Ram Hospital, New Delhi. Patients of more than 60 years of age in whom AVF was created from 1st January 2012 to 31st December 2016 were included in the study. Follow-up data of 3.5 years was analysed. The primary endpoint was to assess primary and secondary patency rates. Results A total of 300 patients were included in the study. The mean age was 63.8 years. Radiocephalic AVF (RCAVF) was the most common site of [69.8% (n = 210)], followed by brachiocephalic (BCAVF) in 25.2% (n = 75) and basilic vein transposition (BVT) in 5% (n = 15). At 12 months, overall survival of the AVF was 66.8%. At 42 months, the primary patency rate of RCAVF, BCAVF, and BVT was 50.6%, 52.6%, and 50.4% respectively. The commonest cause of access failure was thrombosis (20.4%) followed by non-maturation (9%). Vascular access abandonment was found least in BCAVF. Conclusion AVF remains the preferred vascular access for haemodialysis in the elderly population. Brachiocephalic AVF has higher primary and secondary patency rates. Thrombosis and failure of maturation are major concerns in the elderly AVF.

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Long-Term Outcomes of Staged Basilic Vein Transposition for Hemodialysis Access in Children

The Journal of Vascular Access ◽

10.5301/jva.5000778 ◽

2017 ◽

Vol 18 (5) ◽

pp. 366-370 ◽

Cited By ~ 1

Author(s):

Elias Kfoury ◽

Christopher J. Demaree ◽

Mun J. Poi ◽

Jesus M. Matos ◽

Carlos F. Bechara ◽

...

Keyword(s):

Tertiary Care ◽

Primary Patency ◽

Secondary Patency ◽

Hemodialysis Access ◽

Basilic Vein ◽

Long Term Outcomes ◽

Av Fistula ◽

Functional Maturation

Introduction Children requiring long-term hemodialysis often face significant challenges due to their young age and small-vessel caliber for arteriovenous (AV) access creation. In this study, we report our experience of staged basilic vein transposition (BVT) in pediatric patients. Methods All patients undergoing staged BVT at a tertiary care pediatric hospital from 2003 to 2015 were reviewed. Indications for staged BVT included inadequate cephalic conduit or failed AV fistula using cephalic vein. Pertinent clinical variables were analyzed to determine treatment outcomes. Results Forty-two children (24 males, 57%) underwent 46 staged BVT during the study period. Median age was 12.8 ± 4.8 years (range 3-18). The mean weight was 47 ± 5.1 kg (range, 13-126 kg), with four children (10%) weighing ≤20 kg. Mean operative times for initial brachiobasilic AV fistula and staged BVT were 39 ± 12 minutes and 66 ± 17 minutes, respectively. Mean follow-up period was 5.4 ± 1.8 years. Functional maturation was achieved in 93% of BVTs. Early fistula thrombosis within 30 days following BVT occurred in four patients (10%). Late BVT thrombosis occurred in 13 patients (31%). Primary patency rates at 2 years and 4 years were 78% and 72%, respectively. Secondary patency rates at 2 years and 4 years were 86% and 82%, respectively. Conclusions Staged BVT is a durable and reliable autologous hemodialysis access in children who do not have adequate cephalic venous conduit.

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One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art

The Journal of Vascular Access ◽

10.1177/1129729819862694 ◽

2019 ◽

Vol 21 (3) ◽

pp. 281-286 ◽

Cited By ~ 3

Author(s):

Mohamed Sheta ◽

Jalal Hakmei ◽

Mark London ◽

Mathew Wooster ◽

John Aruny ◽

...

Keyword(s):

Meta Analysis ◽

Primary Patency ◽

Secondary Patency ◽

Search Term ◽

Complication Rates ◽

Basilic Vein ◽

Two Stage ◽

Pubmed Search ◽

Adequate Quality ◽

Student’S T

In the absence of suitable cephalic vein, the brachiobasilic vein complex represents the best option for arteriovenous access. However, the basilic vein is too deep to cannulate and requires transposition to be accessible. Transposition can be performed during fistula creation (single-stage BBTx) or at a second operation after initial fistula creation (two-stage brachiobasilic transposition (BBTx)). The best approach is unknown. A PubMed search using “Basilic vein transposition” as the primary search term was performed to identify articles addressing this controversy. Meta-analysis was then performed using those papers that provided the inspected data points with student’s t-test used to compare maturation and patency rates between the groups. A total of 37 manuscripts were judged of adequate quality for analysis. Based on the available data, overall maturation rates, 1-year primary patency rates, and overall complication rates seem to be equivalent between single- and two-stage BBTx, while 1-year secondary patency is greater in the two-stage group (79% vs 85%). A large prospective randomized clinical trial with clear definitions of maturity, patency, and complications is needed to definitively answer the question of whether one strategy is better than the other.

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The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access

The Journal of Vascular Access ◽

10.1177/1129729818764137 ◽

2018 ◽

Vol 19 (6) ◽

pp. 596-601

Author(s):

Maciej Zielinski ◽

Nicholas Inston ◽

Zbigniew Krasinski ◽

Marcin Gabriel ◽

Grzegorz Oszkinis

Keyword(s):

Vascular Access ◽

False Aneurysm ◽

Perioperative Complications ◽

Primary Patency ◽

Secondary Patency ◽

Basilic Vein ◽

Arterial Diameter ◽

Male Predominance ◽

Peripheral Arterial

Introduction: The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. Aims: The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Material and methods: Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. Results: From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27–80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1–60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Conclusion: Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.

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Mid-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia

Surgical Techniques Development ◽

10.4081/std.2011.e2 ◽

2011 ◽

Vol 1 (1) ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

Eva Schönefeld ◽

Susanne Szesny ◽

Konstantinos P. Donas ◽

Georgios A. Pitoulias ◽

Giovanni Torsello

Keyword(s):

Endovascular Treatment ◽

Mesenteric Ischemia ◽

Primary Patency ◽

Mesenteric Arteries ◽

Primary Study ◽

Symptom Improvement ◽

Initial Symptom ◽

Secondary Patency ◽

Chronic Mesenteric Ischemia

The authors would present the mid-term outcomes with the use of stent-supported angioplasty in the treatment of symptomatic chronic mesenteric ischemia (CMI). The present study is a retrospective analysis of 36 patients undergoing endovascular treatment of symptomatic CMI, between November 2000 and September 2009. Primary study endpoints were defined as primary patency, periprocedural and midterm mortality and complications, and symptom improvement after intervention. Forty-one mesenteric arteries (77.3% stenotic and 22.7% occluded vessels) were treated in 36 patients with 42 stents. In 30 patients (83.3%) one visceral artery and in 6 cases (16.7%) two visceral arteries were treated. Overall mortality was 16.7% (n=6) after a 60-month follow-up (mean follow-up period 30.1 months). Two early (<30-day) deaths were caused by visceral ischemia (n=2: 5.5%). Late death was procedure-related in one patient with re-occlusion of the superior mesenteric artery after 12 months. The other 3 patients died from non procedure-related causes; e.g. twice myocardial infarction. Initial symptom relief was observed in 29 patients (80.5%); 7 patients reported no change. Primary patency was 83.3% after 5 years and secondary patency was 90.5% (38 out of 42 stents) among all patients. Two conversions to open surgery were documented. First-line endovascular approach of CMI is a reasonable strategy. Close follow-up is mandatory due to symptom recurrence and restenosis.

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Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh161228138d ◽

2018 ◽

Vol 146 (5-6) ◽

pp. 316-319

Author(s):

Branislav Donfrid ◽

Olivera Lozance ◽

Zvezdan Stefanovic ◽

Aleksandar Jankovic ◽

Nada Dimkovic

Keyword(s):

Vascular Access ◽

Brachial Artery ◽

Duplex Sonography ◽

Distal Region ◽

Original Method ◽

Late Complications ◽

Primary Patency ◽

Chronic Hemodialysis ◽

Secondary Patency ◽

Basilic Vein

Introduction. The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline. The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion. AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.

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MILLER Banding Procedure for Treatment of Dialysis Access–Related Steal Syndrome, Pulmonary Hypertension, and Heart Failure

The American Surgeon ◽

10.1177/00031348211056259 ◽

2021 ◽

pp. 000313482110562

Author(s):

Ahmad Alqassieh ◽

Patrick B. Dennis ◽

Veena Mehta ◽

June Shi ◽

Angello Lin ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Vascular Access ◽

Primary Patency ◽

Secondary Patency ◽

Dialysis Access ◽

Long Term Follow Up ◽

Steal Syndrome

A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access–related steal syndrome (DASS) and high-flow vascular access–related pulmonary hypertension (PHT) and heart failure (HF). We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates. A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively. The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.

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Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

Surgical Endoscopy ◽

10.1007/s00464-019-07364-y ◽

2020 ◽

Vol 35 (1) ◽

pp. 104-112

Author(s):

Vilja Koskensalo ◽

Marianne Udd ◽

Mia Rainio ◽

Jorma Halttunen ◽

Matias Sipilä ◽

...

Keyword(s):

Abdominal Pain ◽

University Hospital ◽

Long Term Results ◽

Biliary Duct ◽

Complication Rates ◽

Biliary Sphincterotomy ◽

Significant Difference ◽

Upper Abdominal

Abstract Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

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Provisional Stenting Using the Zilver PTX Drug-Eluting Stent After Drug-Coated Balloon Angioplasty: Initial Experience From the Double Drug Dose “3D” Study

Journal of Endovascular Therapy ◽

10.1177/1526602819884062 ◽

2019 ◽

Vol 27 (1) ◽

pp. 34-41

Author(s):

Fabrizio Fanelli ◽

Alessandro Cannavale ◽

Michele Citone ◽

Mariangela Santoni ◽

Marianna Gazzetti ◽

...

Keyword(s):

Primary Patency ◽

Drug Eluting Stent ◽

Secondary Patency ◽

Systemic Complications ◽

Aneurysm Formation ◽

Drug Eluting ◽

Provisional Stenting ◽

Zilver Ptx ◽

Drug Coated Balloon

Purpose: To explore the provisional use of a drug-eluting stent (DES) after suboptimal drug-coated balloon (DCB) angioplasty in complex, calcified femoropopliteal lesions. Materials and Methods: A prospective, single-center, investigator-initiated pilot study enrolled 15 patients (mean age 71.3 years; 9 men) with symptomatic stenosis (n=6) or occlusion (n=9) of the native superficial femoral and/or proximal popliteal arteries who experienced suboptimal DCB dilation despite postdilation. Lesion characteristics were evaluated with computed tomography angiography and duplex ultrasound confirmed by intravascular ultrasound. Follow-up included clinical and imaging evaluations as well as blood tests to monitor inflammatory markers. Endpoints included systemic inflammation, acute/chronic thrombosis, aneurysm formation, and mortality. Results: Provisional stenting was required for residual stenosis >50% in 4 cases and flow-limiting dissection in 11. Provisional spot stenting was done using the Zilver PTX DES. Clinical improvement was observed in all cases. After 24-month follow-up all patients were alive and in good clinical condition. One- and 2-year primary patency rates were 93.3% and 92.9%, respectively; secondary patency was 100%. Restenosis required reintervention in 2 cases. No local or systemic complications or toxicity were observed due to the use of a double dose of paclitaxel. No significant increase in any inflammation marker was observed in the perioperative period, and no aneurysm formation was seen over 24 months of follow-up. Conclusion: Combined DCB plus DES therapy seems to be safe and correlated with high primary patency following suboptimal angioplasty. Larger studies are required to confirm the safety and efficacy of this approach.

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