Comparison of Elevation and Transposition Techniques for Brachiobasilic Arteriovenous Fistula: A Prospective Observational Study

Background: Brachiobasilic fistula (BBF) is an established vascular access option in patients with end-stage renal disease when distal fistulas are not suitable. Superficialization of the basilic vein can be achieved using elevation or transposition techniques. Objective: To compare maturation, patency, and complication profiles of brachiobasilic arteriovenous fistulas (AVFs) created using the elevation and transposition techniques. Materials and Methods: This prospective observational study included 56 patients undergoing BBF creation at a tertiary care center, with 29 patients in the elevation group and 27 in the transposition group. Preoperative Doppler ultrasonography was performed for vascular assessment. Postoperative follow-up included clinical examination and duplex ultrasonography at 6 and 12 weeks. The outcomes assessed were fistula maturation, time to first cannulation, primary and secondary patency at 3 and 6 months, and procedure-related complications. Results: Baseline demographic, clinical, and preoperative Doppler parameters were comparable between the two groups. Overall fistula maturation rate was 98.2%, with no significant difference between the two techniques. Primary patency at 3 months was 79.3% in the elevation group and 81.5% in the transposition group, while primary patency at 6 months was 72.4% and 66.7%, respectively; the differences were statistically insignificant. Secondary patency at 3 and 6 months was 89.7% in the elevation group and 92.6% in the transposition group, with no significant difference. Wound-related complications were more frequent in the elevation group, whereas vascular complications were comparable between the two groups. Conclusion: Both elevation and transposition techniques provide satisfactory maturation and patency outcomes for brachiobasilic AVFs. The main differences between techniques were wound-related complications.