Author(s): Manmeet Singh, S. N. Sankhwar
BACKGROUND The National Kidney Foundation- Dialysis Outcomes Quality Initiative Guidelines recommend primary use of autogenous arteriovenous access in patients of chronic renal failure waitlisted for haemodialysis. In spite of troublesome comorbidities associated with BVT, it is still the most preferred technique when autologous veins are not available to construct radiocephalic or brachiocephalic fistula. The present study highlights our experience with BVT with small incision technique over a period of three years with excellent outcome. MATERIALS AND METHODS This retrospective study included all the patients who underwent BVT at our tertiary care center between August 2013 and August 2016. It was performed in patients with failed previous RCF or BCF or who had small caliber or thrombosed cephalic veins. The patients with minimum 3 mm basilic vein diameter on Doppler were only included in the study. A 3-cm horizontal incision was made in antecubital fossa to expose brachial artery and basilic vein. Multiple longitudinal separate second skin incisions (2-3 cm) were made to explore proximal part of basilic vein. Side branches of the vein were isolated and ligated. The divided basilic vein in antecubital fossa was brought over fascia through newly-created subcutaneous tunnel followed by end-to-side anastomosis. RESULTS A total of 30 (20 males and 10 females) underwent BVT in the three years period. The mean fistula maturation time was 40 ± 10 days. Maturation rate was 100% and the postoperative flow rate was 280 ± 22 (mL/min.). No bleeding, thrombosis, failure, pseudoaneurysm or rupture occurred in our patients. Arm oedema occurred in 6 (20%) patients, infection in 4 (13%) and lymphorrhoea in 5 (17%). The mean follow-up was six months. CONCLUSION BVT is an alternative method with excellent initial maturation and functional patency rates requiring less extensive skin incision and surgical dissection. It is the most durable haemodialysis access procedure for those patients having multiple forearm AVF surgeries.