CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
364
AFRICA
Comparison of one- and two-stage basilic vein
transposition for arterio-venous fistula formation in
haemodialysis patients: preliminary results
SEDAT OZCAN, ALİ KEMAL GÜR, ALİ ÜMİT YENER, DOLUNAY ODABAŞI
Abstract
Objective:
This study aimed to compare the results of one-
and two-stage basilic vein transposition (BVT) in haemodi-
alysis patients.
Methods:
This was a non-randomised, retrospective study
between January 2007 and January 2012 on 96 patients
who were diagnosed with end-stage renal failure (ESRF) (54
males, 42 females; mean age 43.6
±
14 years) and underwent
one- or two-stage BVT in our clinic. All patients who were
not eligible for a native radio-cephalic or brachio-cephalic
arterio-venous fistula (AVF) were scheduled for one- or two-
stage BVT after arterial (brachial, radial and ulnar) and
venous (basilic and cephalic) Doppler ultrasonography.
Patients were retrospectively divided into two groups:
group 1, basilic vein diameter
>
3 mm and patients who
underwent one-stage BVT; and group 2, basilic vein diam-
eter
<
3 mm and patients who underwent two-stage BVT. In
group 1, the basilic vein with a single incision was anasto-
mosed to the brachial artery, followed by superficialisation.
In group 2, the basilic vein was anastomosed to the brachial
artery and they underwent the superficialisation procedure
one month postoperatively. Fistula maturation and postop-
erative complications were assessed.
Results:
The mean diameter of the basilic vein was statisti-
cally significantly higher in group 1 (3.46
±
0.2 mm) than in
group 2 (2.79
±
0.1 mm) (
p
<
0.05). In terms of postoperative
complications, thrombosis, haemorrhage and haematoma
were significantly higher in group 1 (34, 36 and 17%, respec-
tively) than in group 2 (23, 14 and 6%, respectively) (
p
<
0.05). The rate of fistula maturation was significantly lower
in group 1 (66%), compared to group 2 (77%) (
p
<
0.05).
Time to fistula maturation was significantly shorter in group
1 (mean 41
±
14 days), compared to group 2 (mean 64
±
28
days) (
p
<
0.05).
Conclusion:
Two-stage BVT was superior to one-stage BVT
due to its lower rate of postoperative complications and high-
er fistula maturation, despite its disadvantage of late fistula
use. Although the diameter of the basilic vein was larger in
patients who underwent one-stage BVT, we observed that
one-stage BVT was disadvantageous in terms of postopera-
tive complications and fistula maturation.
Keywords:
renal dialysis, arterio-venous fistula, basilic vein
transposition, complication
Submitted 11/6/13, accepted 25/10/13
Cardiovasc J Afr
2013;
24
: 364–368
DOI: 10.5830/CVJA-2013-077
In recent years, the number of patients requiring haemodialysis
(HD) has been rapidly increasing globally, including Turkey.
Arterio-venous fistula (AVF) is the most frequently used method
in patients with end-stage renal failure (ESRF) for HD.
1
The Kidney Disease Outcome Quality Initiative (KDOQI)
recommends autologous radio-cephalic or brachio-cephalic AVF
as a primary method of choice in HD patients, and basilic vein
transposition (BVT) as a secondary option.
2,3
In 1976, Dagher
et
al
.
4
first described the technique of BVT for HD. In later years,
several techniques were used.
5-11
This study aimed to compare the
patency and complication rates of AVF formed by one-stage and
two-stage BVT.
Methods
Between January 2007 and January 2012, 96 patients (54
males, mean age 43.6
±
14 years) who were not eligible for
radio-cephalic and brachio-cephalic AVF via native veins and
who underwent BVT were included in this retrospective study.
Patients were selected according to basilica vein diameter,
which was evaluated with vascular Doppler. Group 1 consisted
of patients with a basilic vein diameter
>
3 mm and who
underwent one-stage BVT (47 patients, 28 males; mean age
42.8
±
14.5 years), and group 2 contained patients with a basilic
vein diameter
<
3 mm and who underwent two-stage BVT (59
patients, 36 males; mean age 44.5
±
13.5 years).
In group 1, the incision was performed through the basilic
vein located in the medial condyle of the humerus and axillary
area. The vein was carried over the fascia by tying the lateral
branches during release of the basilic vein, while the
nervus
cutaneus medialis
of the forearm was preserved. The basilic vein
in the antecubital fossa was anastomosed to the brachial artery
end to side, using 6-0 or 7-0 polypropylene continuous sutures.
Following evaluation of the presence of thrill, the fascia and
other layers were closed, lifting the vein and protecting the nerve.
One month was allowed for the anastomosed graft to heal before
the possible trauma of HD injection.
In group 2 patients, the incision was made through the basilic
vein located in the medial and lateral condyle of the humerus and
was it anastomosed to the brachial artery laterally using 6-0 or
7-0 polypropylene continuous suture. The incisions were closed
in the anatomical layers, after the presence of thrill was evaluated.
In the next stage at one month, an incision was made through
the basilic vein located in the medial condyle of the humerus and
Department of Cardiovascular Surgery, Çanakkale Onsekiz
Mart University, Çanakkale, Turkey
SEDAT OZCAN, MD,
ALİ ÜMİT YENER, MD
Department of Cardiovascular Surgery, Yuzuncu Yil
University, Van, Turkey
ALİ KEMAL GÜR, MD
DOLUNAY ODABAŞI, MD
