Purpose: An Ulnar artery-forearm basilic vein arteriovenous fistula (UBAVF) is not often used for hemodialysis access because the vessels are anatomically deep structures, the basilic vein is often not well developed, and access to this vein for
subsequent puncturing is difficult, and the arm position is uncomfortable because of its position on the medial side of the arm. To evaluate the role of this fistula in selected patients with no other accessible autogenous cephalic veins and
failed
autogenous vein fistula, we conducted this study. Methods: From March 1998 to August 1999, 164 arteriovenous fistula (AVF) formations were done in 151 patients who required chronic hemodialysis in Seoul and Chungnam National University Hospitals
by
one
surgeon. Among them, ten (6.1%) UBAVFs were included. UBAVF formation could be considered in all cases of primary AVF and failed AVF, but the following criteria were necessary for selection of ulnar-basilic fistula: (1) No accessible forearm
cephalic
veins on either sides, (2) Presence of pulsation of radial, ulnar arteries and a normal Allen test, (3) Luminal diameter of the basilic vein greater than or equal to 3 mm and confirmation of patency of the proximal venous outflow by manual
percussion.
Single incisions were used in the majority of cases, and longer maturation time before initiation of hemodialysis was recommended compared with other autogenous vein fistulas. One- and two-year primary patency rates and the early failure rate
were
analyzed and compared with those for vein fistulas of the other sites. Satisfaction of patients with this fistula was evaluated by direct or phone communication with the patients and dialysis nursing personnel. Results: Mean age was 45.1 years
(21∼67
years) and male to female ratio was 6：4. Four cases (40%) were done as a primary AVF, and six were as a second or more AVF. Mean follow-up period was 15.3 months, and no major complications occurred, except for one case of early thrombotic
occlusion.
Difficulty of needle cannulation by dialysis nursing personnel and uncomfortable arm positioning during hemodialysis were negligible. Early failure occurred in one case and a total of three fistulas failed during the follow-up period. One-and
two-year
primary patency rates of UBAVF were 78.8% and 67.5%, respectively. There were no statistically significant differences in patency rates between UBAVF and other autogenous vein fistulas during the same period. Conclusion: In my experience, UBAVF
in
selected patients demonstrated a low early failure rate, an acceptable patency rate, and minimal complications. Difficulty of needle cannulation and uncomfortable arm positioning during hemodialysis were minimal, but agreement and education about
postoperative discomfort, even planning of vein transpositions, must be considered. In addition, because of location in the forearm, preservation of more proximal vasculature for future hemodialysis access procedures was possible. I recommend
selective
use of this fistula to increase the use of autogenous vein fistula and to maximize options for hemodialysis access while reducing the dependency on synthetic graft fistula
|