Acute and long term cardiovascular effects of basilic vein transposition in chronic renal failure patients

Factors affecting cardiac function in dialysis patients include arterial blood pressure, anemia, intra-vascular volume and the arteriovenous fistula (AVF). We investigated the acute and chronic effects of basilic vein transposition (mean upper arm brachial artery-basilic vein anastomosis) on both the cardiovascular system and the oxygen status. Sixteen patients with end stage renal failure were enrolled in this study. Patients with heart failure, pericardial effusion or valvular heart disease were not included in the study. Echocardiography (preoperatively and six months after, stages 1 and 2 respectively) and a Swan-Ganz catheter (perio-peratively) were used to assess the hemodynamic status during the phases of AVF construction. Flow measurements were made in the parts of the AVF system before, during and after the constru-ction of the AVF.Moreover, at the same time phases blood sampling from the arterial line and the pulmonary artery catheter was performed, in order to assess oxygen and acid-base status. Cardiac output, cardiac index, stroke volume, stroke volume index, left ventricular stroke work in-creased statistically significant 20 and 30min after the AVF construction and they returned to base-line at 40min after the procedure. On the contrary, systemic vascular resistance decreased statisti-cally significant 20 and 30min after the operation and they remained decreased for the whole study period. No other differences were recorded regard-ing the hemodynamic, oxygen and acid-base status. As far as the echocardiographical findings are con-cerned, ejection fraction showed a tendency to increase but not significantly in contrast to the inter-ventricular septum which increased statistically significant in both systole and diastole (p<0.01). Posterior wall thickness decreased minimally in both systole and diastole. Regarding the AVF sy-stem diameters, there were no changes recorded during the study. Basilic vein transposition in selected patients provides a well functioning AV fistula and is not an appreciable cause of circulatory or pulmonary congestion for at least a period of six months.