Two Stage Brachio-Basilic Transposition Fistula Provides Superior Patency for Chronic Haemodialysis: Our Experience in SIMS/ SHL

Muhammad Khalid Butt; Omer Sabir; Ghulam Mehboob Subhani; Azfar Ali; Nauman Bashir; Nauman Tarif

doi:10.29054/apmc/2014.362

Muhammad Khalid Butt Professor of Urology Sargodha Medical College, Sargodha
Omer Sabir Senior Registrar of Nephrology Fatima Memorial Hospital, Lahore
Ghulam Mehboob Subhani Associate Professor of Urology PMC / Allied Hospital, Faisalabad
Azfar Ali Senior Registrar of Urology Services Institute of Medical Sciences (SIMS), Lahore
Nauman Bashir Assistant Professor of Urology LMC Gurki Hospital Lahore
Nauman Tarif Head of Nephrology Fatima Memorial Hospital, Lahore

DOI: https://doi.org/10.29054/apmc/2014.362

Keywords: Arteriovenous Fistula, Brachiobasilic fistula, Haemodialysis, Transposition

Abstract

Background: Adequate vascular access is of utmost importance for hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair cannulation and can cause significant complications and inconvenience for the technicians and patients. Objective: We intended to present the technique of superficialization (transposition) of the brachiobasilic fistula (BBF) and its clinical outcome regarding patency & complications. Materials & Methods: Twenty two brachiobasilic fistulas were fashioned in 20 patients between October 2010 to November 2011.The second stage superficialization (transposition) was carried out at a median of 59.1 days (range: 40-90 days) after fistula formationand involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the antero-medial aspect of the arm and transposing it beneath skin. Results: During the study period 20 brachiobasilic fistulas (BBF) were fashioned in 20 patients. There were 8 (40%) males and 12 (60%) females. The mean age was 53.45years + 12.34 years (range: 21-70years). The patency rates were 90% at 6 months. Surgical complications of transposition were infection in 2 (10%) patients and lymphocoele in 4 (20%) patients. Conclusion: Transposition of brachiobasilic fistulas is technically feasible and relatively safe procedure. Patency rates at 6 months are excellent.