One-Stage vs Two-Stage Brachiobasilic Arteriovenous Fistula with Superficialization of the Basilic Vein Regarding Patency and Failure Rates

Abstract

Safe, reliable and durable vascular access is essential for successful hemodialysis. Long term patency rates demonstrate that native AV fistulae has the best outcome compared to other methods e.g. synthetic grafts and double lumen catheter. Autogenous AVF also has lowest cost and lowest infection rate. (1)(2)(3) The patency rate of AVFs in most parts of the world is 60-70% in first year and 50-60% in second year. The primary failure rate of an AVF ranges between 50-54% during the first six months. (4)(5) Ineffective AVF and its complications are among the most important problems of chronic kidney disease (CKD) patients. Some of the complications are thrombosis, infection, stenosis, aneurysm formation and distal limb ischemia. (6) BBAVF was first described by Cascardo and his associates (54) and Dagher and his colleagues in the 1970s.(55)(56) The superficialization of BBAVF can be achieved by one of two methods: (1) transposition technique where the entire length of basilic vein is mobilized and positioned anterolaterally under a subcutaneous flap or (2) the elevation