Abstract
Permanent vascular access for chronic hemodialysis requires a reliable structure with adequate blood flow. Endogenous arteriovenous (AV) fistulas offer the best outcomes, but standard radiocephalic fistulas are not always feasible. A reliable alternative is a transposed basilic vein-brachial artery AV fistula, which offers a number of advantages over synthetic AV grafts. The transposed basilic vein fistula provides high flow rates along with low rates of infection, thrombosis, and other complications; however, longer maturation times may be necessary. This longer maturation time may necessitate the use of a “bridge device” for access. The new, fully subcutaneous vascular access device - the LifeSite® Hemodialysis Access System - offers several significant advantages over a standard dialysis catheter as a bridge device: higher flow rates without recirculation, as well as lower rates of infection, thrombosis, and hospitalization. This article describes the surgical procedure for the creation of the transposed basilic vein fistula and the implantation procedure for the LifeSite System. We report on the use of this combined sequential approach to vascular access in 14 patients with excellent results. All 14 patients initially implanted with the LifeSite System were successfully bridged to a functional transposed basilic vein fistula. The mean flow rate with the LifeSite System was 450 ml/min; only one device had to be removed due to infection in an HIV-positive patient, and no other complications were observed. The mean time to maturation of the transposed basilic vein fistula was 6 months; the upper arm fistulas delivered a mean flow rate of 1100 ml/min with a 100% patency rate at 6 months. The sequential use of the LifeSite System and a transposed basilic vein fistula represents a valuable approach to increasing the usage of a high flow native AV fistula.
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