SS03 - Long-term results of brachial vein transposition as a autologous arteriovenous vascular access

Objectives: National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines prefers autologous arteriovenous fistula (AVF) to arteriovenous graft (AVG) for vascular access in hemodialysis patients with good clinical circumstances. When superficial veins are absent, basilic vein transposition (BVT) can be an alternative. However, for some patients, neither AVF nor BVT is feasible. Although previous studies have reported the efficacy of brachial vein transposition (BrVT), the long-term patency is unclear. The objective of this study is to clarify the long-term patency of BrVT.

Methods: Consecutive patients receiving BVT or BrVT from January 2005 to March 2022 were enrolled in the study. Patients receiving BVT were classified into BVT group, and those receiving BrVT were into BrVT group, with overlap allowed. Demography, operation time, and duration from construction to initial cannulation were compared between BVT and BrVT group. Both primary patency and secondary patency at one year, two years, and five years after construction of vascular access in BVT and BrVT group were respectively observed. The Kaplan-Meier method was used to compare the primary and secondary patency of BVT and BrVT.

Results: Overall, 134 cases were enrolled; 103 cases in BVT group and 31 cases in BVT group. Regarding patient demography, no significant difference was observed between BVT group and BrVT group. No significant difference was observed in operation time (minute, BrVT: 182±56 vs BVT: 169±37, P = 0.13) or in duration to initial cannulation (day, BrVT: 24±7 vs BVT: 35±33, P = 0.10). Primary patency at one year, two years, and five years was 45%, 40%, and 6.7% in BrVT group, and 45%, 27% and 10% in BVT group. No significant difference was observed between Kaplan-Meier curves of two groups at one year, two years and 5 years (P = 0.75, 0.65, and 0.98, respectively). Secondary patency at one year, two years, and five years was 70%, 65%, and 57% in BrVT group, and 89%, 80%, and 69% in BVT group. Secondary patency in BVT group was higher than that in BrVT group at any observation period. Kaplan-Meier curves at one year showed significant difference only at one year (P = 0.018, 0.06, and 0.14, respectively).

Conclusions: Although BrVT has a tendency of lower secondary patency, primary patency of BrVT was comparable to that of BVT. No significant difference was observed in operation time, duration to initial cannulation, indicating BrVT could be another candidate for autologous AVF.