Basilic Vein Transposition:The Critical Importance of Vein Diameter

Objective: We evaluated our experience with a slightly more complex method of creating autogenous hemodialysis access--the upper arm basilic vein transposition (BVT).
Methods: All patients (48) undergoing this procedure during a twelve month period were included in this study and their medical records thoroughly reviewed.
Results 36 (75%) patients had patent grafts of which 24 were functional (currently being accessed for acceptable hemodialysis.) There were fifteen (31%) failures during this time period and 88% (43) of the total group had prior access procedures. Review of all pre-operative vein mappings relative to functionality of the BVT revealed that a 4 mm diameter threshold was critical. Patients in whom the maximum basilic vein diameter (MVD) did not exceed 4.0mm had a significantly lower incidence of having a functional BVT (20% v. 75%) than if the MVD was greater than 4.0 mm (χ² = 6.691; p=.0097.)
Conclusions: This initial study underscores the critical role of the Noninvasive Vascular Laboratory in increasing autogenous fistula creation in a progressively aging population--a goal of the Fistula First Breakthrough Initiative. Accurately assessing basilic vein diameter is of great importance prior to subjecting patients, with multiple comorbidities, to the magnitude of operation required to transpose an upper arm basilic vein.