Transposed Brachiobasilic Arteriovenous Fistula versus Prosthetic Arteriovenous Graft: A Comparative Cohort Analysis of Primary Patency and Complication Profiles in Hemodialysis Patients

Abstract

Background: Establishing durable vascular access is a critical determinant of outcomes in patients receiving hemodialysis. When the superficial cephalic vein is anatomically unsuitable or exhausted, clinicians must choose among alternative access strategies, primarily a transposed brachiobasilic arteriovenous fistula (tBBAVF) or a prosthetic arteriovenous graft (AVG). Objectives: This study compared short-term primary patency and complication profiles, particularly hemodialysis access-induced distal ischemia (steal syndrome), between a tBBAVF and a prosthetic AVG. Methods: This retrospective cohort study evaluated adult hemodialysis patients who underwent tBBAVF placement (n = 30) or upper-extremity expanded polytetrafluoroethylene (ePTFE) AVG placement (n = 30) at a tertiary academic center between March 2020 and March 2024. Because of constraints in synthetic graft availability, a census sampling strategy was used (N = 60). The primary endpoint was 6-month primary patency. Univariate cross-tabulations using chi-square tests and independent-samples t tests were performed to analyze determinants of patency and postoperative outcomes. Results: The total cohort (n = 60; mean age, 63.0 ± 12.9 years) had high baseline rates of hypertension (76.7%, n = 46) and diabetes mellitus (50.0%, n = 30). At 6 months, overall primary patency was maintained in 51.7% of patients (n = 31). Chi-square analysis showed no statistically significant difference in 6-month primary patency between the tBBAVF group (56.7%, n = 17) and the AVG group (46.7%, n = 14) (x2 = 0.601, P = 0.438). Male sex was a significant univariate predictor of higher 6-month primary patency (x2 = 5.380, P = 0.020). The overall incidence of steal syndrome was 46.7% (n = 28) and was not significantly associated with vascular access type (x2 = 0.268, P = 0.605). However, diabetes mellitus was significantly associated with a higher incidence of steal syndrome (x2 = 4.290, P = 0.038). Conclusions: Short-term (6-month) primary patency did not differ significantly between the tBBAVF and prosthetic AVG cohorts. However, the wide confidence intervals reflect substantial uncertainty due to the limited sample size; therefore, the nonsignificant difference should not be interpreted as definitive clinical equivalence or non-inferiority. Access selection should remain individualized. The high incidence of steal syndrome, particularly among patients with diabetes, supports the need for rigorous preoperative arterial assessment.