Authors:

Abstract

Introduction

With increasing prevalence of chronic kidney disease worldwide, the demand for long-term renal replacement therapy is on the incline. Apart from renal transplantation, this includes sustainable vascular access for long-term haemodialysis, often requiring secondary and tertiary access.

Objective

To assess the place of Transposed Brachio-Basilic Arterio- Venous Fistula (TBB-AVF) as a second line access compared to prosthetic Aretrio Venous Grafts (AVG), with emphasis on functional patency and access related morbidity and mortality.

Study Design

A prospective cohort study (January 2014 to March 2016) comparing TBB-AVF and AVG, at the National Institute of Nephrology Dialysis and Transplantation, Colombo, Sri Lanka.

All patients where venous mapping revealed no suitable cephalic vein were included. Those who preferentially opted for a central venous catheter, those requiring urgent initiation of dialysis or considered unfit for TBB-AVF or AVG creation were excluded. TBB-AVF was performed where the basilica vein was patent and >2 mm. AVG was used when it was <2mm or when haemodialysis was expected to commence within 4 weeks.

Results

459 patients were enrolled; 382(83%) TBB-AVF and 77(17%) AVG. Mean follow-up was 11(± 4.8) months. There were 9 deaths, all >4 weeks from access creation and not directly related to the access. The all-cause mortality rate was 5/382 (1.3%) TBB-AVF and 4/77 (5.2%) AVG; p=0.02. Surgical site infections were seen in 24 (6.4%) TBB-AVFs and 10 (13.7%) AVGs; p=0.03. The overall functional patency at six months was 307/375 (81.9%) in TBB-AVF and 57/73 (78.1%) in AVGs; p=0.45.

Conclusion

TBB-AVF provide comparable medium term functional patency to AVG and are associated with a significantly less incidence of all-cause mortality and surgical site infection.

Keywords: Renal dialysis,  Central venous catheters,  Arteriovenous fistula,  Kidney failure chronic,  Axillary veins