November 16, 2006

Should DOQI Guidelines be updated? The Role of Basilic Vein Fistula

Anantha K. Ramanathan, MBBS¹, Nader D. Nader, MD², Maciej L. Dryjski, MD¹, Hasan H. Dosluoglu, MD², Gregory S. Cherr, MD³, Richard G. Curl, MD³, Alan S. Kuritzky, MD¹, Linda M. Harris, MD¹.
¹Millard Fillmore (Gates) Hospital, Buffalo, NY, USA, ²Veterans Administration Hospital, Buffalo, NY, USA, ³Buffalo General Hospital, Buffalo, NY, USA.

Should DOQI Guidelines be updated?
The Role of Basilic Vein Fistula
Objective: DOQI guidelines relegate basilic vein fistulae (BVF) to a second tier procedure. The goal of this paper was to evaluate the appropriateness of this recommendation by comparing outcomes of BVF to cephalic vein fistulae (CVF).
Methodology: A chart and dialysis record review of AV fistulae created between January 2001 and July 2005 was performed. Primary, assisted primary and secondary patency, demographics, comorbidity and complications were compared by life table analyses, Chi Square or T test as appropriate, using SPSS (Illinois, Chicago).
Results: One hundred fifty-six patients (88 males; 68 females; mean age 61) underwent creation of 172 AV fistulae. There were 101 BVF and 71 CVF. Table 1 tabulates patency. Primary failure was significantly higher for CVF than BVF (28% vs. 13%; p=0.01). Time to maturation and usage time were not significantly different between BVF and CVF. Thirty-three (33%) BVF and 12 (17%) CVF required revision during the follow up period (p=0.02). Complications were similar for BVF and CVF.
Conclusions: BVF performed at least as well as CVF in terms of patency, maturation time, usage time and complication rates, though requiring more reinterventions. DOQI guidelines should be revised to recognize the value of BVF as a 1^st tier option, in patients who do not have suitable forearm veins.

**Table 1**
Type	Primary Patency%			Asst Primary Patency%			Secondary Patency%
Type	1 year	2 years	3 years	1 year	2 years	3 years	1 year	2 years	3 years
BVF⁺	61	42	24	73	49	40	78	61	58
CVF All	48	43	43	53	49	49	56	52	52
CVF U Arm(47)	46	35	35	57	45	45	62	51	51
p=	ns	ns	ns	0.02*	ns	ns	0.01*	0.03*	0.03*
⁺ all but 2 BVFs were upper arm basilic vein transpositions ^* The difference was between CVF All and BVF, When upper arm CVF are compared to BVF, there was no difference

Table of Contents

Table 1

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