Autogenous brachial-basilic upper arm transposition as an alternative for prosthetic upper arm vascular access for haemodialysis - review paper

Abstract

The aim of this literature review is to assess brachiobasilic arteriovenous fistula (BBAVF) for haemodialysis as an alternative for arteriovenous graft (AVG) in the upper arm.
BBAVF, first described by Dagher in 1976, can be created as a one- or two-stage procedure. The twostage procedure allows the utilization of a basilic vein of small diameter, which, when arterialized, can be transposed into the subcutaneous tunnel after a few weeks. The inability to use the basilic vein for BBAVF creation was described in 5-7% of cases. Distal extremity ischaemia after BBAVF placement was reported in 2.9% of cases, stenoses in 2.3%, thrombosis in 9.7%, infection in 3.6%, arm oedema in 3.7%, high output cardiac failure in 0.2%, and pseudoaneurysm formation in 1.9% of cases. The small number of accesses in the studied groups, their heterogeneity, the lack of randomization in the majority of papers and the use of inconsistent patency rate definitions make versatile and reliable comparison difficult. Reinterventions due to complications of BBAVFs were less frequent than those due to complications of AVGs. Primary patency rates of BBAVFs at 12 and 24 months were 72% (35-92%) and 60.4% (28-86%) respectively, and secondary patency rates at 12 and 24 months were 74.6% (55-96%) and 67.5% (52-86%) respectively.
Anatomical abnormalities, stenoses, and occlusion rarely involve the basilic vein. A two-stage procedure allows an increase in the number of autogenous vascular accesses. In comparison to AVGs, BBAVFs less frequently undergo re-interventions due to complications, their patency rates are comparable to brachiocephalic fistulas, and in many instances are higher than those of AVGs. BBAVF is an advantageous alternative for upper arm AVG.