We sought to determine whether using 2 stage bvt improves maturation use and patency compared with other avfs including arteriovenous av grafts. One stage and two stage approaches patients with a prior history of access surgery and a smaller basilic vein diameter were more likely to undergo a two stage bbavf procedure one stage procedure had more arm swelling more endovascular intervention and less open surgery.
The size of the basilic vein increased from 0 3 0 027 cm before the performance of the first stage of the bvt to 0 79 0 08 cm after the first stage of the two stage bvt.
Two stage basilic vein transposition. First creation of the fistula. Two stage basilic vein transposition bvt allows maturation of smaller veins often a limiting factor in the pediatric population before elevation and use. Creation of a brachial artery basilic vein ﬁstula also known as a basilic vein transposition bvt may be per formed as either a one stage or two stage operation 5 the two stage technique waits until the ﬁstula has matured to bring the vein near the skin surface whereas the one stage procedure completes the av anastomosis.
All patients had to have direct arterialization of the basilic vein therefore patients with previous ipsilateral wrist fistulas also followed a two stage protocol. One stage and two stage bbt avf creations 4 5 the one stage procedure involves dissecting and mobiliz ing the basilic vein and transposing into the superﬁcial subcutaneous layer before anastomozing it to the brachial artery all in one sitting. Bvts were performed in two stages.
Basilic vein transposition bvt fistulae are increasing in prevalence in the united states. Transposition can be performed during fistula creation single stage bbtx or at a second operation after initial fistula creation two stage brachiobasilic transposition bbtx. Of these 42 were created in one stage and 58 in two.
The two stage procedure is most beneficial when the upper arm veins are of borderline size 2 5 3 5 mm. Of the 16 failures in the other avf group 11 were primary failures occurring before attempted access. A one stage basilic vein transposition usually matures if the basilic vein is larger than 3 5 mm but a two stage basilic vein transposition should be constructed if the vein is between 2 5 and 3 5 mm.
Second transposition of the vein using three small incisions in the arm. We examined outcomes of bvt fistulae created in a single stage compared to those created in two stages. Prospective qa databases identified a consecutive cohort of 144 patients with bvt fistulae.
The two stage procedure on the contrary only creates the brachiobasilic anastomosis.