Strategies for the Creation and Maintenance of Reconstructed Arteriovenous Fistulas Using the Forearm Basilic Vein

Cost-effectiveness analysis of radiobasilic and brachiobasilic arteriovenous fistulas in hemodialysis patients

We evaluated the cost and efficacy of radiobasilic and brachiobasilic arteriovenous fistula (AVF) methods in terms of forearm autogenous arteriovenous access in hemodialysis patients. We used a decision tree to compare the cost-effectiveness of proximal radiobasilic AVF (pRBAVF) and brachiobasilic AVF (BBAVF), considering the mean direct medical costs and patency rates. The overall mean cost of pRBAVF per patient (1767.59 Turkish lira [TL]) was lower than that of BBAVF (1877.99 TL). Also, the mean patency duration per patient was higher for pRBAVF (25.72 months) than BBAVF (20.21 months). The incremental cost-effectiveness ratio (ICER) showed that pRBAVF was 20.04-fold more effective than BBAVF. The monthly ICERs also favored pRBAVF, which was less costly and more effective. The pRBAVF provided clinical and economic benefits for hemodialysis patients requiring forearm autogenous arteriovenous access. pRBAVF was more effective in terms of patency than BBAVF, and was also less expensive.

Transcutaneous intravascular transposition of a permanent dialysis catheter

Permanent catheters are used to provide long-lasting access for long-term dialysis therapy in certain patients when creating an arteriovenous fistula between their own vessels is not possible, when there are contraindications for fistula creation or when the expected lifetime of the patient is short. We present the case of a patient with terminal renal insufficiency treated with hemodialysis for 5 years. Due to post-thrombotic changes and venous stenosis resulting from long-term cannulation with dialysis catheters, the replacement catheter was inserted through the previously used canal and transcutaneous intravascular catheter transposition was performed.