Zahid Parvez, Ajmal Hasan Naqvi.
A Comparison of Economy and Efficacy of Vascular Access for Hemodialysis with PTFE Graft and ExtraAnatomical Subcutaneous Placement of Basilic Vein.
Proceeding Shaikh Zayed Postgrad Med Comp Jan ;23(1):69-74.

Native arteriovenous fistula is the method of choice for chronic intermittent hemodialysis. When it is not possible, the options for vascular access are either brachio-basilic arteriovenous fistula with subcutaneous placement of basilic vein or the use of a prosthetic implant, as recommended by the Kidney Disease Outcome Quality Initiative (KDOQI) and European guidelines. Aim: To find out reasonable and economical alternate method of vascular access, in patients with previous multiple access failure. Methods: During the period from February 2008 to July 2009, 29 patients prospectively enrolled in the study and the patients were divided into two groups according to the selection criteria. Group1. Patients selected for insertion for PTFE graft. Group 2. Patients selected for Extra- Anatomical Subcutaneous placement of basilic vein (EASPBV). Results: Equal distributions were seen regarding the preoperative patient characteristics and other risk factors in the both groups. No immediate failure of AVF in the both groups. A primary early patency rate was 93.8% and 92.3%, twelve months patency rate was 87.5% and 84.6%,and 22 months patency rates were 81.3% and 77% in group one and two respectively. In group 1, One patient with graft developed early symptoms of infection, managed with appropriate antibiotics. Two other patients in the same group had thrombosis and graft occlusion after eight months and one year respectively, after the first prick in the graft for hemodialysis . One female patient of this group developed distal ischemia of the hand and we had to remove the graft 15 days after its insertion. In group 2 male patient with diabetes and hypertension got wound infection, his basilic one vein thrombosed within few days resulting in failure of the fistula. A 23 years old patient got false aneurysm of the basilic vein 5 cm distal to the anastmosis at the puncture site of the arteriovenous fistula after 14 months, it is still functioning and is under follow up. The group one with AVF with graft shows more tendencies for bleeding, thrombosis, and distal ischemia of the limb while group to with AVF with EASPBV shows more tendencies towards false aneurysm formation. The arteriovenous fistula with subcutaneous placement of the basilica vein has significantly low cost. Conclusion: The both methods of vascular access have good comparable results. The AVF with EASPBV has advantage of less complications and being more cost effective.

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