Comparison of basilic vein transposition and arteriovenous graft for hemodialysis access with respect to patency complications and dialysis initiation time in a short-term prospective cohort study

This study compared short-term access patency, time to first dialysis, and early complications between two-stage basilic vein transposition (BVT) and prosthetic arteriovenous graft (AVG) used for hemodialysis access. A prospective observational cohort of 74 patients was conducted at a tertiary referral center between May to December 2024. Participants were allocated to BVT or AVG based on predefined anatomical suitability criteria (including basilic vein diameter > 2 mm) and the operating surgeon’s clinical judgment. Allocation was not randomized. In borderline cases (e.g., basilic vein diameter close to 2 mm or ambiguous ultrasound findings), final assignment was determined after joint review by the surgical team to minimize subjective variation. However, surgeon-level preference and anatomical heterogeneity may still have influenced allocation, representing a potential source of selection bias.The primary outcome was short-term access patency, secondary outcomes included time to first dialysis, infection, and bleeding. Generalized linear model analyses were adjusted for age, sex, prior access history, and basilic vein diameter. Mean short-term access patency was similar between groups (BVT: 11.08 ± 1.95 weeks; AVG: 10.79 ± 2.13 weeks; p = 0.45). Time to first dialysis was significantly shorter in the AVG group (2.61 ± 0.68 weeks) than in the BVT group (19.36 ± 3.13 weeks; p < 0.001). Postoperative infection occurred in two AVG patients (5.3%) and none in the BVT group; bleeding occurred in one AVG patient (2.6%) and none in the BVT group. Differences in complication rates between groups were not statistically significant. BVT and AVG demonstrated comparable short-term access patency during the limited follow-up period, but AVG allowed substantially earlier initiation of hemodialysis. Although AVG may be advantageous for patients requiring urgent access, BVT remains a reliable option with low early complication rates. The choice of vascular access should be individualized based on clinical context, urgency of dialysis initiation, and long-term access considerations. These findings reflect short-term outcomes only and cannot be interpreted as long-term patency performance.