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Lu E, Baril DT, Arbabi CN, Chou EL, Azizzadeh A, Gupta N. Outcomes of prosthetic upper arm arteriovenous graft vs brachiobasilic fistula for hemodialysis access. J Vasc Surg 2024:S0741-5214(24)01225-4. [PMID: 38909916 DOI: 10.1016/j.jvs.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Primary arteriovenous access such as radiocephalic and brachiocephalic fistulas are initial choices for creating vascular access in dialysis patients. When neither of these choices is an option, upper arm arteriovenous graft or brachiobasilic transposition is recommended. Although primary fistula is better than prosthetic graft for suitable patients, there is little data to guide the best treatment strategy in the absence of suitable vein for primary access creation. This study identifies factors that influence patency rates and compares outcomes of patients treated with brachiobasilic fistula vs upper arm graft in patients who have failed forearm access or are not candidates for primary access. METHODS A prospectively maintained database of patients with dialysis-dependent renal failure from 2010 to 2022 was analyzed. Primary, primary assisted, and secondary patency rates were calculated. Incidence rates of complications and reinterventions were compared. RESULTS There were 148 patients with brachiobasilic fistulas and 157 patients with upper arm grafts. The graft group was older (70.1 ± 14.7 vs 62.5 ± 14.6 years; P = .003) and had a higher incidence of pacemakers (11.9% vs 4.1%; P = .005). Brachiobasilic fistulas had higher 6-month (77.0% vs 64.3%; P = .02) and 1-year (68.2% vs 55.4%; P = .03) primary-assisted patency. Secondary patency rates were better for upper arm grafts at 1-year (82.2% vs 72.3%; P = .05). Access complications of non-maturation and aneurysm were higher in basilic vein transposition (21.6% vs 1.3%; P < .0001; 15.5% vs 6.4%; P = .017). Grafts had higher rates of occlusion (58.0% vs 25.7%; P < .0001). In terms of interventions, upper arm grafts had higher rates of thrombectomy (50.3% vs 18.9%; P < .0001), but there was no difference seen in angioplasty, stent, surgical revision, or steal procedures. Basilic vein transpositions had longer time to cannulation (104.6 ± 81.1 vs 32.5 ± 22.4 days; P < .0001), longer total catheter days (251.1 ± 181.7 vs 72.9 ± 56.3 days; P < .0001), and higher number of procedures to aid maturity (0.7 ± 0.7 vs 0.1 ± 0.3; P < .0001). CONCLUSIONS In this retrospective analysis, when forearm access or primary arteriovenous access is not an option, basilic vein transposition and upper arm grafts have fairly equivalent primary patency. Primary assisted patency is slightly better in basilic vein fistulas, but secondary patency is better in upper arm grafts at 1 year. Basilic fistulas also had longer time to cannulation, longer total catheter days, and more procedures to aid maturity.
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Affiliation(s)
- Eileen Lu
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Donald T Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Cassra N Arbabi
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elizabeth L Chou
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ali Azizzadeh
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Navyash Gupta
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Koudounas G, Giannopoulos S, Houser A, Karkos C, Volteas P, Virvilis D. Basilic vein tunnel transposition versus elevation transposition for brachiobasilic arteriovenous fistula creation: A systematic review and meta-analysis. J Vasc Access 2024:11297298241226993. [PMID: 38336667 DOI: 10.1177/11297298241226993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
This study aimed to compare basilic vein tunnel transposition (BVTT) to basilic vein elevation transposition (BVET) technique for superficialization of a basilic arteriovenous fistula. This is a systematic review and meta-analysis comparing outcomes between BVTT and BVET for brachiobasilic arteriovenous fistula (AVF) creation. Primary endpoints were primary patency at several time intervals during follow-up and postoperative local complications, whereas secondary endpoints included primary assisted patency and secondary patency. A random effects model meta-analysis was conducted, and the I2 statistic was used to assess heterogeneity. Nine eligible studies were identified, including 543 patients (247 in the BVTT group and 296 in the BVET group). BVTT group was associated with inferior primary patency rate at 6 months compared to BVET group (three studies; OR: 0.43; 95% CI: 0.22-0.83; I2 = 0%; p = 0.012). However, primary patency rates were similar between the two study groups at 12 months (six studies; OR: 0.64; 95% CI: 0.33-1.22; I2 = 40.7%; p = 0.176), and at 24 months (six studies; OR: 0.86; 95% CI: 0.32-2.29; I2 = 74.9%; p = 0.764). No significant differences in terms of primary assisted patency, secondary patency, and postoperative complications were detected between the groups. More specifically, wound infection (BVTT: n = 9/150; BVET: n = 6/186; OR: 1.39; 95% CI: 0.48-4.06; I2 = 0%; p = 0.542) and healing of the scar, particularly regarding arm edema (BVTT: n = 18/100; BVET: n = 27/165; OR: 1.11; 95% CI: 0.57-2.18; I2 = 0%; p = 0.755) and hematoma formation (BVTT: n = 14/173; BVET: n = 42/209; OR: 0.40; 95% CI: 0.13-1.19; I2 = 49%; p = 0.101), did not differ significantly between the two study groups. BVET achieved superior primary patency at 6 months compared to BVTT, but this benefit seems to be lost during longer follow-up intervals. Therefore, both surgical techniques provide similar long-term outcomes.
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Affiliation(s)
- Georgios Koudounas
- Vascular Unit, 5th Department of Surgery, Aristotle University Medical School, Hippokratio Hospital, Thessaloniki, Greece
| | - Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Alex Houser
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Christos Karkos
- Vascular Unit, 5th Department of Surgery, Aristotle University Medical School, Hippokratio Hospital, Thessaloniki, Greece
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Dimitrios Virvilis
- Department of Vascular and Endovascular Surgery, St Francis Hospital & Heart Center, Roslyn, NY, USA
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Masood B, Batool Zaidi SA, Alam S, Mir S. Single stage versus two stage basilic vein transposition for hemodialysis access: A retrospective observational study. J Vasc Access 2023:11297298231210952. [PMID: 37997037 DOI: 10.1177/11297298231210952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The basilic vein transposition is a brachio basilic arteriovenous fistula (AVF) made after the mobilization and transferring of basilic vein to the ventral aspect of arm inside a subcutaneous pocket by direct dissection. The procedure can be performed either in single stage or two stages. This study compares the clinical efficacy and long term utility of single-stage and two-stage basilic vein transposition among patients of renal failure and to evaluate failure rate, primary patency rates, and postoperative complications. METHOD Patients who underwent basilic vein transposition at Sindh Institute of Urology and Transplantation, Karachi from January 2021 to December 2021 were retrospectively reviewed. Patients were divided into two groups according to single stage or two-stage procedure. After the surgical procedure, assessment of fistula maturation and surveillance were undertaken using ultrasound and physical examination. Patients were requested to visit the out-patient clinic for assessment of fistula patency and post-operative complications at regular intervals of 3, 6, and 12 months respectively. RESULT During the 12 months' interval, 82 (39.04%) basilic vein transpositions were performed in single-stage and 128 (60.95%) were two-staged transposition. In our analysis we have found that as compared to single stage, two-stage basilic vein transpositions showed significantly better primary patency rates (76.82% vs 96%; p-value 0.000) and required less interventions for maintaining fistula patency. More post-operative sequelae were noted in the single stage version of the procedure as compared to the two stage procedure. CONCLUSION Two stage procedure of basilic vein transposition is found to have better patency rate and lesser post-surgical complications. However, a matched cohort prospective study is still needed to further strengthen the conclusion.
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Affiliation(s)
- Bilal Masood
- Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | | | - Shabina Alam
- Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Shuahullah Mir
- Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
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Dabas AK, Patra V, Metia S, Mahapatra D, Jha VK, Srivastava S. Early Experience with Sine Wave Technique for Superficialization of a difficult to cannulate Arterio Venous Fistula. Ann Vasc Surg 2021; 80:120-129. [PMID: 34688876 DOI: 10.1016/j.avsg.2021.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To highlight safety and efficacy of sine wave technique (SWT) in superficializing deep arterio venous fistula (AVF) and managing infiltrations and other complications. METHODS It is a single center observational study done from Jul 2017 to July 2020. All successive cases of deep AVFs, aneurysm / pseudoaneurysms of AVFs, and AVFs requiring open venoplasty were managed with SWT. Data was collected prospectively and analyzed. SWT is based on random pattern skin flaps. Using ultrasound, a line is marked on either side of centre line (AVF) at a distance of approximately 1.5-2 cm. A sine wave is drawn starting from either of the lines to the other with multiple crests and troughs. The base of flap should be double the height of the flap, that is, about 3-4 cm. Skin is incised and flaps are raised at level of AVF. Excess fat is removed. A sliver of unhealthy skin can be sacrificed if required. Flaps are sutured back to restore sine wave continuity. RESULTS SWT was used in a total of eleven patients. Median age was 58 years (range 10-67 years). Eight were females and three males. One was radio-cephalic and rest were brachio-cephalic AVFs. Eight AVFs were deep with median depth of 10.25mm (range 8-13mm), median body mass index of 25.5 kg/m2 (range 23.9-26.5kg/m2), median vein diameter of 7 mm (range 6-8 mm), and median flow rate of 1137.5ml/min (range 650- 1380 ml/min). Out of eight, four AVFs presented with infiltration. In other three, SWT was used for exposing AVF to treat underlying pathology (one case each of aneurysm, pseudoaneurysm & stenosis). Ten cases were done under local or regional anesthesia and one under general anesthesia. There was no peri-operative mortality or loss of AVF. Transient limb oedema developed in one case. Median time to cannulate was 20 days (range 13-28 days). Median follow up was 13 months (range 6 - 31months). Cumulative patency at 18 months was 90% (95% CI 47.3%-98.53%) and 45 % (95% CI 9.9%-87.1%) at 24months and at the end of the study. CONCLUSION SWT is safe and effective in superficialization of deep / difficult to cannulate AVF as well a good approach to treat complications like infiltration. Post procedure cannulation time is reasonably short.
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Affiliation(s)
- Ajay Kumar Dabas
- Earlier: Department of Surgery (Vascular Division) Command Hospital Air Force, Bangalore. Karnataka, India.; Now: Department of Surgery (Vascular Division) Command Hospital, Udhampur, J& K. India..
| | - Vikram Patra
- Earlier: Department of Surgery (Vascular Division) Command Hospital Air Force, Bangalore. Karnataka, India.; Presently: Dept of Vascular Surgery, Army Hospital (R & R), Delhi, India..
| | - Sebasish Metia
- Department of Surgery (Vascular Division) Command Hospital, Pune, India..
| | - Debashish Mahapatra
- Earlier Department of Medicine (Nephrology Division) Command Hospital Air Force, Bangalore. Karnataka, India.; Now: Department of Medicine (Nephrology Division) 7 Air Force Hospital, Kanpur. UP, India..
| | - Vijoy Kumar Jha
- Department of Medicine (Nephrology Division) Command Hospital Air Force, Bangalore. Karnataka, India..
| | - Sachin Srivastava
- Department of Medicine (Nephrology Division) Command Hospital Udhampur, J & K, India..
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Muhammad Saleh W, Rehman ZU, Hashmi S. Maturation and Patency Rates in Basilic Transposition Arteriovenous Fistula Under Regional Versus General Anesthesia: A Single-Center, Retrospective, Observational Study. Cureus 2021; 13:e16991. [PMID: 34540394 PMCID: PMC8422592 DOI: 10.7759/cureus.16991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/06/2022] Open
Abstract
Background Basilic transposition arteriovenous fistula (BT AVF) is a viable option for dialysis-dependent patients, which can be performed under either general or regional anesthesia. Regional anesthesia is reported to cause vascular dilatation during the perioperative period, leading to improved fistula success. Regional anesthesia is also considered safe as compared to general anesthesia in terms of hemodynamic stability. Limited and conflicting data are available comparing regional versus general anesthesia in terms of fistula maturation and patency. We aimed to compare the maturation, one-year patency rates, and complication rates in patients undergoing single-stage BT AVF in regional versus general anesthesia. Methods This retrospective observational study was conducted on patients undergoing single-stage BT AVF from January 2016 to December 2019. Patients were divided into regional (RA) vs. general anesthesia (GA) groups and compared in terms of maturation, one-year patency, and perioperative complication rates. Results Out of 152 patients, 110 (72.37%) were in GA while 42 (27.63%) were in the RA group. Elderly, female, diabetic, ischemic heart disease, and American Society of Anesthesiologists (ASA) class IV patients were more in the RA group. Other comorbid and vascular access-related factors were comparable between the groups. A trend toward higher maturation rates (97.6% vs. 92.1%) and one-year patency rates (62.5% vs. 56.6%) was observed in the RA vs. GA group, however, the difference did not attain statistical significance, p=0.359 and p=0.327, respectively. The rate of access abandonment was higher in the GA group (43.4% vs. 37.5%). The most prevalent cause of abandonment was death in the RA group while it was access failure in the GA group. Overall complication rates were comparable between both groups (20.2 % vs. 17.5%, p=0.816). Conclusion Regional anesthesia is a useful technique with potentially improved maturation and patency rates. Nevertheless, an assumed benefit of regional anesthesia in terms of anesthesia-related complications was not observed.
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Affiliation(s)
- Waryam Muhammad Saleh
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, PAK
- Department of Vascular and Endovascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Zia U Rehman
- Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Shiraz Hashmi
- Department of Surgery, Aga Khan University Hospital, Karachi, PAK
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Kim C, Yun WS. Clinical outcomes of transposed brachial-basilic vein fistula: Tunneling versus elevation. J Vasc Access 2021; 23:899-903. [PMID: 34027735 DOI: 10.1177/11297298211018076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Kidney Disease Outcome Quality Initiative (KDOQI) suggests a transposed brachial basilic vein fistula (TBBVF) in the patients who have good likelihood of long-term survival. To superficialize the basilic vein, a disconnected basilic vein is anterolaterally transposed inside a subcutaneous tunnel. A simple elevation in situ is an alternative technique. The aim of this study was to compare clinical outcomes of TBBVF according to the type of superficialization. METHODS A total of 42 patients (mean age of 66 years, male: 45%) who underwent a TBBVF from April 2014 to March 2019 at our hospital were retrospectively reviewed. The method of superficialization (tunneling (n = 18) vs elevation (n = 24)) was determined by the surgeon's preference. It was done as a one-stage surgery. There was not any statistically significant difference in demographic or clinical characteristics of patients between the two groups. As early outcomes, postoperative mortality and morbidity were investigated. For clinical outcomes, primary patency, primary-assisted patency, and secondary patency were analyzed for both groups. RESULTS There was a case of a 30-day mortality in the elevation group. Regarding morbidities, there was a postoperative bleeding in the tunneling group and a steal syndrome in the elevation group. The mean follow-up was 28 months (range, 0-63 months). There was no significant difference in primary patency (64.8% vs 77.5% in 1 year and 54.0% vs 54.1% at 3 year; p = 0.816), primary-assisted patency (88.9% vs 86.5% in 1 year and 88.9 vs 81.4 at 3 year; p = 0.624), or secondary patency (100% vs 86.5% in 1 year and 100% vs 86.5% at 3 year; p = 0.126) between the two groups. CONCLUSIONS Clinical outcomes of TBBVF showed no significant difference between tunneling and elevation groups. Thus, TBBVF can be done with either method.
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Affiliation(s)
- Choshin Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Hospital, Daegu, Korea
| | - Woo-Sung Yun
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Ottinger M, Picone D, Hseih K, Wooster M, London MJ, Ross JR, Illig KA. Results of first stage brachiobasilic and brachiobrachial fistula creation: Implications for staged versus single procedure decision making. J Vasc Access 2021; 23:791-795. [PMID: 33934671 DOI: 10.1177/11297298211005247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transposed brachiobasilic AV fistulas (BVT) have increasingly been performed in two stages. Published reports give conflicting results, perhaps in part as many reports of staged procedures eliminate those patients who "fail" the first stage (i.e. are lost to follow-up in addition to anatomic failure). METHODS A prospectively maintained database was reviewed to identify all patients at two institutions who underwent the first stage of planned two-stage BVT by the senior author. Success in this context was defined as patients who eventually underwent second stage fistula creation, leaving the operating room after the second stage with a patent, transposed fistula. RESULTS From October 2012 to June 2020, 218 patients underwent first-stage procedures. At the first visit, 185 (85%) of fistulas were patent, 23 (11%) were occluded, 8 (4%) of patients were lost to follow-up, and 2 (1%) died. In the interval before the second operation, another eight (4%) patients were lost to follow-up, two were cancelled for medical reasons, and two declined surgery, leaving a total of 173 patients who made it to the second stage (80%). At operation, four patients were found to have unusable veins, leaving a total of 169 patients who completed both stages. If all patients who underwent first stage are included, 77% of patients entering this pathway left the OR after their second stage with patent access. If those lost to follow-up are excluded, this number increases to 84%, while if all those lost to follow-up are assumed to mature, success increases to 85%. CONCLUSIONS Depending on results in patients lost to follow-up, between 77% and 85% of patients undergoing first stage brachiobasilic fistulae undergo successful second stage transposition. These numbers are equivalent or slightly lower than published maturation rates for single-stage BVT, so there is little margin for failure at the second stage.
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Affiliation(s)
- Mary Ottinger
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Desiree Picone
- Division of Vascular Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Katrina Hseih
- Dialysis Access Institute, the Regional Medical Center, Orangeburg, SC, USA
| | - Mathew Wooster
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Mark J London
- Dialysis Access Institute, the Regional Medical Center, Orangeburg, SC, USA
| | - John R Ross
- Dialysis Access Institute, the Regional Medical Center, Orangeburg, SC, USA
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Tayebi P, Mahmoudlou F, Daryabari Y, Shamsian A. Brachial Vein Transposition with Consecutive Skin Incisions in a Hemodialysis Patient with Absence of Adequate Superficial Veins: A Case Report. Vasc Specialist Int 2020; 36:263-265. [PMID: 33408292 PMCID: PMC7790689 DOI: 10.5758/vsi.200060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 11/20/2022] Open
Abstract
The creation of an arteriovenous fistula instead of a synthetic vascular graft is a smart decision in hemodialysis patients who do not have a suitable superficial vein. Basilic vein transposition (BVT) is a viable option in most cases, except in patients who do not have a proper basilic vein. In patients with inadequate superficial veins, another source of the autogenous vein is the brachial vein, a deep vein of the upper arm. Most surgeons choose a full medial arm incision to perform brachial vein exploration. We describe a patient in whom BVT was not possible and so brachial vein transposition using skip incisions was performed, with good results.
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Affiliation(s)
- Pouya Tayebi
- Department of Vascular and Endovascular Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Mahmoudlou
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Yasaman Daryabari
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Atefeh Shamsian
- MSc student in nursing, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Cheng CT, Chang YC, Tam KW, Yen YC, Ko YC. Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis. Vasc Endovascular Surg 2020; 55:164-170. [PMID: 33228455 DOI: 10.1177/1538574420969252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis. METHODS A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions. RESULTS Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001). CONCLUSION Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.
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Affiliation(s)
- Chen-Ting Cheng
- School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei
| | - Yuan-Chen Chang
- School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, 38032Taipei Medical University, New Taipei City.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei.,Cochrane Taiwan, 38032Taipei Medical University, Taipei
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, 38032Taipei Medical University, Taipei
| | - Yu-Chen Ko
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, 38032Taipei Medical University, New Taipei City
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Haddad DJ, Jasty VS, Mohan B, Hsu CH, Chong CC, Zhou W, Tan TW. Comparing Outcomes of Upper Extremity Brachiobasilic Arteriovenous Fistulas and Arteriovenous Grafts: A Systematic Review and Meta-Analysis. J Vasc Access 2020; 23:32-41. [PMID: 33198574 DOI: 10.1177/1129729820970789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs). METHODS A systematic review was performed to identify all English publications and abstracts comparing the patency outcomes of upper extremity BBAVFs and AVGs (January 1st, 1994 to April 1st, 2020). The outcomes assessed were 1-year and 2-year primary and secondary patency rates. Pooled odds ratios (OR) were calculated using the random-effects model, and I2 statistic was used to assess between-study variability. RESULTS Twenty-three studies examining 2799 patients were identified and included in the study. The 1-year primary patency rates (OR = 1.68, 95% CI 1.24-2.28, p = 0.001, I2 = 69.40%) and 2-year primary patency rates (OR = 2.33, 95% CI 1.59-3.43, p < 0.001, I2 = 68.26%) were significantly better for BBAVFs than AVGs. Compared to AVGs, the 1-year secondary patency rates (OR = 1.45, 95% CI 1.05-1.98, p = 0.022, I2 = 56.64%) and 2-year secondary patency rates (OR = 1.93, 95% CI 1.39-2.68, p < 0.001, I2 = 57.61%) were also significantly higher for BBAVFs. CONCLUSION The outcomes for upper extremity BBAVFs appear to be consistently superior to prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper extremity basilic vein.
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Affiliation(s)
- David J Haddad
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Babu Mohan
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Wei Zhou
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tze-Woei Tan
- University of Arizona College of Medicine, Tucson, AZ, USA
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Mehra K, Manikandan R, Dorairajan LN, Sreenivasan Kodakkattil S, Kalra S, Kumar R, Murali P. Outcomes of Transposition of Brachiobasilic Arteriovenous Fistula in Two-Stage Technique: A Single-Centre Experience With Literature Review. Cureus 2020; 12:e9949. [PMID: 32983655 PMCID: PMC7510181 DOI: 10.7759/cureus.9949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Arteriovenous fistulae (AVF) are considered a better option for long-term dialysis access. The distal radiocephalic AVF is the most preferred followed by proximal radiocephalic, brachiocephalic and brachiobasilic AVFs (BBAVF) with basilic vein transposition. In case of failure of AVF at other anatomical locations, BBAVF may improve the outcomes for patients needing dialysis for long term. The two-stage technique of BBAVF has easier dissection and lesser devascularisation risk. The disadvantages are need for two interventions and delay in maturation. Materials and Method It was a retrospective observational study including 42 patients who underwent transposition of BBAVF as two-stage procedure from June 2014 to July 2018. The data recorded were demographic characteristics, such as median age, gender, dialysis status at AVF creation and operative duration. Complications like postoperative limb oedema, bleeding and thrombosis of AVF were recorded. Patency and access outcome of AVF were documented at three-month follow-up. Results Among 42 patients, 27 (64.3%) were males. The median age was 50 years. Around 14% of patients had minor complications like oedema. Eight (19%) patients needed re-exploration due to bleeding or thrombosis. The early access failure rate that is a failure before discharge was 4.7%. The patency rate at three months was 90.5%, but the primary functional rate was 74%. Conclusion Transposition of BBAVF as a two-step technique is associated with reasonable patency rate and primary functional rate. The related complications were low, and a good number of fistulae could be saved with timely intervention.
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Affiliation(s)
- Ketan Mehra
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Ramanitharan Manikandan
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Lalgudi N Dorairajan
- Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND
| | | | - Sidhartha Kalra
- Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND
| | - Rajeev Kumar
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Padyala Murali
- Urology and Renal Transplantation, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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Kim MS, Min SK, Ahn S, Kim HG, Choi C, Mo H, Han A, Ha J. Modified Brachio-basilic/brachial Arteriovenous Fistula Creation with Short-segment Elevation Preserving the Axilla. Ann Vasc Surg 2020; 67:448.e1-448.e10. [DOI: 10.1016/j.avsg.2020.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
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13
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Basavanthappa R, Luthra L, Gangadharan AN, A RK, M AK, Jp VV, Ar C, Desai SC. Single-stage basilic vein transposition-An effective and viable autogenous access for dialysis. Vascular 2020; 28:760-764. [PMID: 32389064 DOI: 10.1177/1708538120923179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The National Kidney Foundation's/Kidney Disease Outcomes Quality Initiative recommends autogenous arteriovenous fistulas as the preferred method for long-term hemodialysis access. Basilic vein transposition is not only an alternative in patients with failed arteriovenous access but also can be the first option for arteriovenous access in patients with inadequate cephalic vein. Several studies have shown better patency rates, cost-effectiveness, and fewer complications of autogenous access over prosthetic arteriovenous grafts. AIMS AND OBJECTIVES To analyze patency, complication rates, and outcomes of single-stage basilic vein transposition. MATERIALS AND METHODS A single-center retrospective non-randomized study conducted at Ramaiah Medical College and Hospitals, Bangalore from July 2015 to June 2018. A total of 94 consented patients who underwent single-stage basilic vein transposition were included in the study. All the surgeries were done in a single stage under regional anesthesia. All the complications and patency rates were calculated at the end of one year. Statistical analysis was performed using the Chi-square test, and patency rates were assessed using the Kaplan-Meir survival curve. RESULTS A total of 94 single-stage basilic vein transposition was performed. Fifty-four patients had a previous failed autogenous access and 40 had either absent or thrombosed cephalic vein. The mean age was 56.6 years with 59.57% males. The mean basilic vein and brachial artery diameter was 3.6 and 3.8 mm, respectively. The primary patency rate at one year was 84%. Edema and thrombosis were the most common complication in our study. CONCLUSION Single-stage basilic vein transposition is a feasible surgical option in end-stage renal disease patients and provides durable autogenous access with very reasonable outcomes in terms of complication rates and patency rates.
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Affiliation(s)
- Rajendraprasad Basavanthappa
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Luv Luthra
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Ashwini Naveen Gangadharan
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Ranjith Kumar A
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Adharsh Kumar M
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Vivek Vardhan Jp
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Chandrashekar Ar
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Sanjay C Desai
- Department of Vascular and Endovascular surgery, Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
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Jeong H, Bae M, Chung SW, Lee CW, Huh U, Kim MS. Videoscopic Surgery for Arteriovenous Hemodialysis Access. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:28-33. [PMID: 32090055 PMCID: PMC7006609 DOI: 10.5090/kjtcs.2020.53.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
Background When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. Methods Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. Results Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). Conclusion Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.
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Affiliation(s)
- Hyuncheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
| | - Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
| | - Sung Woon Chung
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
| | - Chung Won Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
| | - Up Huh
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
| | - Min Su Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
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Sheta M, Hakmei J, London M, Wooster M, Aruny J, Ross J, Illig KA. One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art. J Vasc Access 2019; 21:281-286. [DOI: 10.1177/1129729819862694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the absence of suitable cephalic vein, the brachiobasilic vein complex represents the best option for arteriovenous access. However, the basilic vein is too deep to cannulate and requires transposition to be accessible. Transposition can be performed during fistula creation (single-stage BBTx) or at a second operation after initial fistula creation (two-stage brachiobasilic transposition (BBTx)). The best approach is unknown. A PubMed search using “Basilic vein transposition” as the primary search term was performed to identify articles addressing this controversy. Meta-analysis was then performed using those papers that provided the inspected data points with student’s t-test used to compare maturation and patency rates between the groups. A total of 37 manuscripts were judged of adequate quality for analysis. Based on the available data, overall maturation rates, 1-year primary patency rates, and overall complication rates seem to be equivalent between single- and two-stage BBTx, while 1-year secondary patency is greater in the two-stage group (79% vs 85%). A large prospective randomized clinical trial with clear definitions of maturity, patency, and complications is needed to definitively answer the question of whether one strategy is better than the other.
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Affiliation(s)
- Mohamed Sheta
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - Jalal Hakmei
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - Mark London
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - Mathew Wooster
- Medical University of South Carolina, Charleston, SC, USA
| | - John Aruny
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - John Ross
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
| | - Karl A Illig
- Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA
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16
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Agarwal AK, Haddad NJ, Vachharajani TJ, Asif A. Innovations in vascular access for hemodialysis. Kidney Int 2019; 95:1053-1063. [DOI: 10.1016/j.kint.2018.11.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
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17
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Drouven JW, de Bruin C, van Roon AM, Oldenziel J, Zeebregts CJ. Outcomes of basilic vein transposition versus polytetrafluoroethylene forearm loop graft as tertiary vascular access. J Vasc Surg 2019; 69:1180-1186. [DOI: 10.1016/j.jvs.2018.06.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
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18
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Comparison of one-stage and two-stage upper arm brachiobasilic arteriovenous fistula in the Vascular Quality Initiative. J Vasc Surg 2019; 69:1187-1195.e2. [DOI: 10.1016/j.jvs.2018.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022]
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19
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Fontseré N, Mestres G, Yugueros X, Jiménez M, Burrel M, Gómez F, Ojeda R, Rodas LM, Lozano V, Riambau V, Maduell F. Brachiobasilic arteriovenous fistula with superficialisation and transposition the basilic vein in a one stage surgical technique. Five years of single experience. Nefrologia 2019; 39:388-394. [PMID: 30853141 DOI: 10.1016/j.nefro.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/21/2018] [Accepted: 11/25/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The basilic vein is a deep vein which usually requires superficialisation and surgical transposition. MATERIAL AND METHODS This is a retrospective study of 119 BBAVF-ST in patients with stage 5D chronic kidney disease who received an implant with a one-stage surgical technique (2011-2015). The percentage of primary (PP), assisted primary (APP) and secondary (SP) permeabilities were assessed, as well as the related complications. We analysed the permeabilities using Kaplan-Meier survival curves and a univariate Log Rank analysis (Mantel-Cox). P values less than or equal to 0.05 were considered as significant. RESULTS The mean age of the study group was 67.9years, with 63.8% of the subjects being male. A total of 57 complications were detected during the follow-up period: 24 stenosis (42.1%), 11 thrombosis (19.2%), 7 vascular access steal syndromes (12.2%), 7 upper limb oedemas (12.2%), 6 post-puncture haematomas (10.5%) and 2 infections (3.5%). The percentages of PP obtained at 1, 6, 12 and 24months were 92.4%, 79.8%, 66.3% and 52%; APP: 94.1%, 87.3%, 80.4% and 65.6%, and SP: 95%, 89.1%, 84% and 67.5%, respectively. Diabetic patients presented with significantly worse permeabilities than vascular or idiopathic patients: (P=.037, .009 and .019, respectively). CONCLUSIONS According to the results obtained in our study, the one-stage surgical implementation of BBAVF-ST presents high permeability rates and a small number of related complications. Diabetes mellitus is a factor related to a worse surgical prognosis. Some of the biggest advantages are the greater optimisation of health resources and a shorter time in which the central venous catheter needs to remain in the body.
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Affiliation(s)
- Néstor Fontseré
- Servicio de Nefrología, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España.
| | - Gaspar Mestres
- Servicio de Cirugía Vascular, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Xavier Yugueros
- Servicio de Cirugía Vascular, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Mario Jiménez
- Servicio de Nefrología, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Marta Burrel
- Servicio de Radiología Vascular Intervencionista, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Fernando Gómez
- Servicio de Radiología Vascular Intervencionista, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Raquel Ojeda
- Servicio de Nefrología, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Lida María Rodas
- Servicio de Nefrología, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Valentín Lozano
- Servicio de Nefrología, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Vicens Riambau
- Servicio de Cirugía Vascular, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
| | - Francisco Maduell
- Servicio de Nefrología, Hospital Clínic; Unidad Funcional de Acceso Vascular, Barcelona, España
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Yu H, Huang B, Yau JWK, Chandrasekar S, Tan GWL, Lo ZJ. Review of Patency Rates between One-Stage and Two-Stage Brachial-Basilic Transposition Arteriovenous Fistulae Creation in an Asian Population. Ann Vasc Dis 2018; 11:318-323. [PMID: 30402182 PMCID: PMC6200625 DOI: 10.3400/avd.oa.18-00041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: To compare patency rates between one- and two-stage (first-stage arteriovenous anastomosis followed by second-stage superficialization) creation of brachial-basilic transposition arteriovenous fistula (BBT-AVF) in an Asian population. Methods: A retrospective review of BBT-AVFs was conducted between July 2008 and March 2015. Kaplan–Meier survival analysis and log-rank test were used to evaluate patency. Results: In total, 103 BBT-AVFs were created in 86 patients (mean age, 61 years; men, 57%). The overall primary, assisted primary, and secondary patency rates at 12, 24, 36, and 48 months were 70%, 48%, 38%, and 35%; 86%, 70%, 62%, and 59%; and 90%, 77%, 70%, and 63%, respectively. There was no significant difference in demographics and preoperative vessel caliber between the groups. The primary failure rate was 24% in the one-stage group, compared with 21% in the two-stage group (p=0.803). There were no statistically significant differences in primary, assisted primary, and secondary patency rates between the groups. Conclusion: There was no significant difference in primary failure and patency rates between the two groups. Both one-stage and two-stage procedures conferred good outcomes with overall 12-month primary patency, secondary patency, and primary failure rates of 70%, 90%, and 23%, respectively.
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Affiliation(s)
- Hongyan Yu
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Baoxian Huang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joachim Wen Kien Yau
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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21
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Jun Yan Wee I, Mohamed IH, Patel A, Choong AM. A systematic review and meta-analysis of one-stage versus two-stage brachiobasilic arteriovenous fistula creation. J Vasc Surg 2018; 68:285-297. [DOI: 10.1016/j.jvs.2018.03.428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/29/2018] [Indexed: 10/28/2022]
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22
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Zielinski M, Inston N, Krasinski Z, Gabriel M, Oszkinis G. The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access. J Vasc Access 2018; 19:596-601. [DOI: 10.1177/1129729818764137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. Aims: The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Material and methods: Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. Results: From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27–80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1–60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Conclusion: Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.
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Affiliation(s)
- Maciej Zielinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, UK
| | - Zbigniew Krasinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Gabriel
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Abstract
The dilemma of creating a fistula in patients without a useable cephalic vein can be addressed by basilic vein transposition, yet results of the classic single-stage procedure are inconsistent and surgeon utilization of this procedure is variable. This article describes a two-staged technique for basilic vein transposition. The two-staged technique is likely to facilitate higher fistula rates in patients unable to have a direct fistula, and warrants consideration by surgeons striving to achieve higher fistula rates
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Affiliation(s)
- A.R. Pasch
- Department of Vascular Surgery, The Wisconsin Heart Hospital, Milwaukee, WI - USA
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24
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Tang V, Morsy M, Chemla E. Using Arteriovenous Fistulae as a Dual Access for Hemodialysis and Total Parenteral Nutrition Administration is Feasible with a Good Outcome: A Case Series. J Vasc Access 2018. [DOI: 10.1177/112972980700800415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
End stage renal failure patients requiring long term total parenteral nutrition (TPN) often have multiple central line placements due to line infection or occlusion. Sometimes this can cause central venous stenosis or even occlusion. We present three cases in this consecutive series, in which we have successfully used arteriovenous fistulae for both hemodialysis and long term TPN administration as an alternative route without any complications. We therefore think that native AVF and grafts can be used as dual access for hemodialysis and TPN administration provided careful case selection, counselling and follow-up.
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Affiliation(s)
- V.C.Y Tang
- South West Thames, Surrey and Sussex Renal Transplant Network, London - UK
| | - M.A Morsy
- South West Thames, Surrey and Sussex Renal Transplant Network, London - UK
| | - E.S. Chemla
- South West Thames, Surrey and Sussex Renal Transplant Network, London - UK
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25
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Milburn J, Lo S, Szucs Z, Humphrey A, Macaulay E. Transposed Brachiobasilic Fistula or PTFE Arm Graft - Alternative or Complementary? J Vasc Access 2018. [DOI: 10.1177/112972980800900207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose Our primary aims were (1) to examine the patency of transposed brachiobasilic (TBB) fistulae compared to arm arteriovenous graft (AVG) without prior transposition, and (2) to examine the patency of AVG with and without prior transposition. Methods Single institution; analysis of prospectively collected data between January 2001 and January 2007. Dedicated database and medical records were reviewed and results analyzed with SPSS. Results Ninety-one patients underwent 111 procedures (52 TBB: 39 AVG as index); 28 TBB failed with 17 (60%) being replaced with an ipsilateral AVG. TBB compared to AVG (without prior TBB) had significantly (log rank <0.05) better primary, primary assisted and secondary patency. Secondary patency at 2 yrs was 47% to 33%, respectively. Ipsilateral AVG after TBB to primary AVG had superior patency rates (secondary patency at 2 yrs 52 vs. 33%) but did not reach significance (log rank =0.073). Combined secondary patency of TBB and AVG after TBB was 81% at 2 yrs. Conclusions The TBB offers an autogenous fistula in the upper arm which has superior patency rates to an arm AVG. Once a TBB has failed an ipsilateral AVG is technically feasible and may offer better patency than a primary AVG.
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Affiliation(s)
- J.A. Milburn
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen - Scotland
| | - S.T. Lo
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen - Scotland
| | - Z.J. Szucs
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen - Scotland
| | - A. Humphrey
- Department of Nephrology, Aberdeen Royal Infirmary, Aberdeen - Scotland
| | - E.M. Macaulay
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen - Scotland
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26
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Beaulieu M, Gabana C, Rose C, Macdonald P, Clement J, Kiaii M. Stenosis at the area of Transposition – An Under-Recognized Complication of Transposed Brachiobasilic Fistulas. J Vasc Access 2018. [DOI: 10.1177/112972980700800409] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background With an increased focus on native AV fistula creation in hemodialysis patients, a transposed brachiobasilic fistula (tBBF) is becoming an increasingly utilized option. This study describes the outcomes of tBBFs in a chronic hemodialysis population. In particular, we focus on the incidence and location of stenosis, and review the impact of angioplasty on these lesions. Methods A retrospective cohort study using all patients with a tBBF created between January 2001 and December 2004. Results Of the 543 fistulas created during the study period, 93 were tBBFs. The mean age of patients was 65 years, 56% were male and 55% were diabetic. Stenosis occurred in 54% (46/85) of fistulas; the location of stenosis in the majority (74%) was at or near the area of basilic vein transposition and 50% of fistulas with stenosis in this location required three or more angioplasties. Primary (unassisted) patency was 42% at one year in this cohort. Secondary patency was 68% at 1 year and 58% and 53% at 2 and 3 years respectively. Conclusion In a cohort of hemodialysis patients who received a tBBF, we describe a reasonable primary and secondary patency rate and a high rate of stenosis at the point of transposition of the basilic vein. Such stenosis usually requires multiple percutaneous or surgical interventions to ensure or reestablish conduit patency. Further study is required regarding the optimal surgical technique, monitoring, and treatment of stenosis of this fistula type including the utility of repeat angioplasty.
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Affiliation(s)
- M.C. Beaulieu
- Division of Nephrology, St. Paul's
Hospital, Vancouver, British Columbia - Canada
| | - C. Gabana
- Division of Nephrology, St. Paul's
Hospital, Vancouver, British Columbia - Canada
| | - C. Rose
- Division of Nephrology, St. Paul's
Hospital, Vancouver, British Columbia - Canada
| | - P.S. Macdonald
- Division of Vascular Surgery, St.
Paul's Hospital, Vancouver, British Columbia - Canada
| | - J. Clement
- Department of Radiology, St. Paul's
Hospital, Vancouver, British Columbia - Canada
| | - M. Kiaii
- Division of Nephrology, St. Paul's
Hospital, Vancouver, British Columbia - Canada
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Weyde W, Krajewska M, Letachowicz W, Kusztal M, Penar J, Klinger M. A new technique for autogenous brachiobasilic upper arm transposition for vascular access for hemodialysis. J Vasc Access 2018; 7:74-6. [PMID: 16868900 DOI: 10.1177/112972980600700206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Conventional brachiobasilic fistula creation consists of the mobilization and preparation of the brachial part of the basilic vein along its whole length, the vein transposition on the anterior surface of the arm and anastomosis using the brachial artery. In case of late thrombosis, the reparation of such a fistula is almost impossible. Methods To avoid total vein clotting in the case of thrombosis we decided to prepare only a short part of the vein in our method and not to mobilize the other part of the vein. The brachiobasilic fistula with our modification was performed as a two-stage procedure in 18 patients (8 females and 10 males), aged from 37–78 yrs (60 ± 13.6 yrs). Results In two patients early thrombosis occurred. The reparation procedure was not performed in two patients (the first patient died due to pneumonia; the second patient did not give his permission for further intervention). In 16 patients brachiobasilic fistula creation was successful. Late thrombotic complications occurred in three patients (in the 3rd, 8th and 12th months). A new successful fistula, a few centimeters proximally to the original one, was performed in 2 patients 24hr and in 1 patient 48hr after fistula clotting. On the following day after the procedure the fistula was ready to be used. The primary, assisted primary and cumulative secondary patency rates after 12 months of follow-up were 74, 89 and 100%, respectively. Conclusion In comparison with standard brachiobasilic techniques our method offers the possibility of a reparation procedure in the case of late thrombosis, which could improve the long-term patency of brachiobasilic fistulas. However, a prospective controlled study is necessary to establish if this new technique is superior to the traditional surgical procedure.
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Affiliation(s)
- W Weyde
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
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Long-term outcomes of staged basilic vein transposition for hemodialysis access in children. J Vasc Access 2017; 18:366-370. [PMID: 28777402 DOI: 10.5301/jva.5000778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Children requiring long-term hemodialysis often face significant challenges due to their young age and small-vessel caliber for arteriovenous (AV) access creation. In this study, we report our experience of staged basilic vein transposition (BVT) in pediatric patients. METHODS All patients undergoing staged BVT at a tertiary care pediatric hospital from 2003 to 2015 were reviewed. Indications for staged BVT included inadequate cephalic conduit or failed AV fistula using cephalic vein. Pertinent clinical variables were analyzed to determine treatment outcomes. RESULTS Forty-two children (24 males, 57%) underwent 46 staged BVT during the study period. Median age was 12.8 ± 4.8 years (range 3-18). The mean weight was 47 ± 5.1 kg (range, 13-126 kg), with four children (10%) weighing ≤20 kg. Mean operative times for initial brachiobasilic AV fistula and staged BVT were 39 ± 12 minutes and 66 ± 17 minutes, respectively. Mean follow-up period was 5.4 ± 1.8 years. Functional maturation was achieved in 93% of BVTs. Early fistula thrombosis within 30 days following BVT occurred in four patients (10%). Late BVT thrombosis occurred in 13 patients (31%). Primary patency rates at 2 years and 4 years were 78% and 72%, respectively. Secondary patency rates at 2 years and 4 years were 86% and 82%, respectively. CONCLUSIONS Staged BVT is a durable and reliable autologous hemodialysis access in children who do not have adequate cephalic venous conduit.
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The Radiobasilic Transposition on the Upper Arm. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2017. [DOI: 10.21673/anadoluklin.284863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mauro R, Pini R, Bianchini Massoni C, Donati G, Faggioli G, Gargiulo M, Freyrie A, La Manna G, Stella A. A Comparison of Two Surgical Techniques for the Second Stage of Brachiobasilic Arteriovenous Fistula Creation. Artif Organs 2016; 41:539-544. [DOI: 10.1111/aor.12788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/03/2016] [Accepted: 05/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Raffaella Mauro
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Rodolfo Pini
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Renal Transplantation Unit; University of Bologna; Bologna Italy
| | - Gianluca Faggioli
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Mauro Gargiulo
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Antonio Freyrie
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplantation Unit; University of Bologna; Bologna Italy
| | - Andrea Stella
- Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Bologna Italy
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Lee Y, Song D, Kim MJ, Yun SC. Upper Arm Basilic Vein Transposition for Hemodialysis: A Single Center Study for 300 Cases. Vasc Specialist Int 2016; 32:51-6. [PMID: 27386452 PMCID: PMC4928604 DOI: 10.5758/vsi.2016.32.2.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/06/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose: The population of end-stage renal failure patients dependent on hemodialysis continues to expand with an increasing number of patients having an unsuitable cephalic vein or failed radio- and brachio-cephalic fistula. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula (BaVT) provides autologous choice for hemodialysis. The results of basilic vein transposition arteriovenous fistula were assessed. Materials and Methods: Three hundred cases of BaVT performed at a single center during the period of January 2005 to December 2011 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods. Results: The median age of patients was 57.4±13.1 years, and 154 patients were male. Renal failure was associated with hypertension in 88.7%, and with diabetes in 34.0%. The mean follow-up was 27.4±20.0 (12 to 72) months. There was no operation-related death. Eighteen patients required prosthetic graft interposition because of short vein. Thirty-five postoperative complications developed in 41 patients (148 cases), including thrombosis, stenosis, hematoma, seroma, arm swelling, steal syndrome, infection and aneurysm formation. Primary patency of BaVT was 69%, 60%, 53%, 52%, 44%, and 22% at 1, 2, 3, 4, 5, and 6 years, respectively. Secondary patency was 99%, 97%, 97%, 97%, 95%, and 95%, respectively. Conclusion: Chronic renal failure patients with hemodialysis may benefit from BaVT, because of high patency, less radiologic procedure, and less infection rate. The BaVT fistula should be used in preference to polytetrafluoroethylene grafts for secondary access.
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Affiliation(s)
- Yunhee Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dan Song
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Myung Jin Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Chul Yun
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Hu D, Li C, Sun L, Zhou C, Li X, Ai Z, Tang J, Peng A. A modified nontransposed brachiobasilic arteriovenous fistula versus brachiocephalic arteriovenous fistula for maintenance hemodialysis access. J Vasc Surg 2016; 64:1059-65. [PMID: 27296523 DOI: 10.1016/j.jvs.2016.03.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE With the growing need for reliable and durable upper arm hemodialysis access, we sought to compare the performance of a novel modified nontransposed brachiobasilic arteriovenous fistula (mNT-BBAVF) with that of the more traditional brachiocephalic arteriovenous fistula (BCAVF). METHODS Briefly, to construct an mNT-BBAVF, an incision is made on the ulnar side of the elbow. The brachial artery and basilic vein are then isolated, and a side-to-side anastomosis is performed without transposition of the basilic vein. Next, the proximal basilic vein and the perforating veins within the surgical field are ligated. In this study, we retrospectively reviewed the medical records of all patients who underwent either an mNT-BBAVF or a BCAVF between January 2011 and October 2014 to compare 1-year primary unassisted patency, cumulative patency, and complications. We also examined hemodynamic parameters of vessels in each fistula type. RESULTS We identified a total of 84 patients: 45 had a BCAVF, and 39 had an mNT-BBAVF. The two groups were well matched for baseline characteristics. Maturation rates at 1 month were 97% for mNT-BBAVF and 96% for BCAVF. The 1-year primary unassisted patency was significantly higher in the mNT-BBAVF group than that in the BCAVF group (87% vs 67%; hazard ratio, 2.86; 95% confidence interval, 1.11-6.40; P = .03), although cumulative patency did not differ (90% vs 73%; hazard ratio, 2.80; 95% confidence interval, 0.98-6.96 ; P = .06). There were no differences in thrombosis, failure of maturation, bleeding, steal syndrome, arm swelling, aneurysm, and stenosis between the two groups during the 12-month study. Importantly, diameters and blood flow volumes of the proximal cephalic vein, distal cephalic vein, and distal basilic vein in patients who received an mNT-BBAVF increased significantly after 12 months. All three vessels met the Kidney Disease Outcomes Quality Initiative (KDOQI) criteria for fistula maturation and were available for dialysis cannulation, whereas only the proximal cephalic vein in the BCAVF group met the maturation criteria and could be used for cannulation. CONCLUSIONS mNT-BBAVF appeared to be an effective alternative to BCAVF for upper arm hemodialysis access.
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Affiliation(s)
- Dayong Hu
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Changbin Li
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Liping Sun
- Department of Ultrasound in Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Chunyu Zhou
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Xinhua Li
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Zisheng Ai
- Department of Preventive Medicine, Tongji University School of Medicine, Shanghai, PR China
| | - Jie Tang
- Division of Kidney Disease and Hypertension, University Medicine, Albert Medical School of Brown University, Providence, RI
| | - Ai Peng
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China.
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Surgical and Endovascular Revision of Brachio-Basilic Vein Fistula. J Vasc Access 2016; 17 Suppl 1:S6-11. [DOI: 10.5301/jva.5000516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose The brachio-basilic vein fistula (BBVF) is currently the third vascular access option for patients on hemodialysis, following radio-cephalic and brachio-cephalic arterio-venous fistulas. Like all types of hemodialysis vascular access, a variety of procedures may have to be performed in order to maintain long-term use of the BBVF. The aim of the present study was to perform a literature review of endovascular or surgical revisions of BBVFs. Methods On Pubmed search, 676 records were obtained and reviewed for relevance with the aim of the search. Results A variety of endovascular and surgical revision techniques has been described to manage BBVF poor maturation, dysfunction manifested as failing BBVF (most often the result of a stenosis at the transposed/swing segment), thrombosis, aneurysm formation and hemodialysis access-induced hand ischemia (steal syndrome). The role of revision is crucial in BBVF maintenance, taking into account that around 70% of these fistulas will require some intervention by 18 months and as a result of revision, secondary patency is preserved in the vast majority, according to the results of one study. Endovascular revision is the treatment of choice for most cases of BBVF dysfunction or thrombosis, with redo surgery reserved for failures of endovascular techniques or other specific indications. Conclusions BBVF revision, more often in the form of endovascular surgery, plays a crucial role in BBVF maintenance and its continued use for hemodialysis, necessary for reducing graft and catheter use and the associated morbidity.
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van Dellen D, Junejo M, Khambalia H, Campbell B. Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency. Ann R Coll Surg Engl 2016; 98:24-8. [PMID: 26688395 PMCID: PMC5234370 DOI: 10.1308/003588414x14055925061757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous 'real estate' but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. Methods A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. Results Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). Conclusion Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity.
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Affiliation(s)
- David van Dellen
- Department of Transplant Surgery, Central Manchester University NHS Foundation Trust, UK
- Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester, UK
| | - Muneer Junejo
- Department of Transplant Surgery, Central Manchester University NHS Foundation Trust, UK
- Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester, UK
| | - Hussein Khambalia
- Department of Transplant Surgery, Central Manchester University NHS Foundation Trust, UK
- Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester, UK
| | - Babatunde Campbell
- Department of Transplant Surgery, Central Manchester University NHS Foundation Trust, UK
- Department of Transplant Surgery, Salford Royal Foundation NHS Trust, Manchester, UK
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Karaca OG, Basal AN, Ecevit AN, Kalender M, Darcin OT, Sungur MA. Radiobasilic Versus Brachiobasilic Transposition on the Upper Arm to Avoid Steal Syndrome. Med Sci Monit 2015; 21:4090-5. [PMID: 26713498 PMCID: PMC4699624 DOI: 10.12659/msm.896642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although the proximal radial artery has been reported as an alternative inflow to prevent steal syndrome, brachiobasilic fistula has been reported to be associated with steal syndrome in 10-20% of cases. We aimed to compare proximal radiobasilic arteriovenous fistula (AVF) with brachiobasilic AVFs on the upper arm in terms of steal syndrome and outcomes. MATERIAL AND METHODS We used our institutional operative record database to identify 94 patients in whom brachiobasilic AVF (n=40) and radiobasilic AVF (n=54) were placed between January 2009 and December 2013. Postoperative complications such as steal syndrome, venous hypertension, and aneurysm were recorded. RESULTS Steal syndrome was determined to occur less frequently in the radiobasilic AVF group (0% vs. 10%, P=0.03). The rates of other complications (bleeding, aneurysm, venous hypertension) between the 2 groups were similar, as were the patency rates. CONCLUSIONS Radiobasilic AVF was effective in reducing steal syndrome, with similar early and late outcomes.
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Affiliation(s)
- Okay Guven Karaca
- Department of Cardiovascular Surgery, Medical Faculty of Duzce University, Duzce, Turkey
| | - Ahmet Nihat Basal
- Department of Cardiovascular Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Ata Niyazi Ecevit
- Department of Cardiovascular Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Mehmet Kalender
- Department of Cardiovascular Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Osman Tansel Darcin
- Department of Cardiovascular Surgery, Medical Faculty of Afyon Kocatepe University, Afyon, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics and Medical Informatics, Medical Faculty of Duzce University, Duzce, Turkey
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Axial splitting of the medial antebrachial cutaneous nerve facilitates second-stage elevation of basilic or brachial vein in patients with arteriovenous fistula. J Vasc Surg 2015; 62:1353-6. [PMID: 26386507 DOI: 10.1016/j.jvs.2015.07.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 07/29/2015] [Indexed: 11/24/2022]
Abstract
We describe a novel surgical technique to facilitate the second-stage elevation of the basilic or brachial vein in patients with first-stage brachial-basilic or autogenous brachial-brachial arteriovenous fistula by axial splitting of the medial antebrachial cutaneous nerve (MABCN). Filaments of the MABCN typically traverse the anterior aspect of the basilic and brachial veins. The second-stage elevation/shelf superficialization of the basilic or brachial vein, so as not to cause an injury to the MABCN, requires division of these veins with transposition over the nerve branches and subsequent reanastomosis. Our method of axial splitting of the MABCN enables elevation and shelf superficialization of the basilic or brachial vein without the division and reanastomosis of the vein. Twenty-eight patients underwent this simplified elevation. The nerve perineurium was incised longitudinally, nerve fibers were divided intrafascicularly, and cutaneous nerve branches were retracted aside. The vein was elevated between the divided nerves. On discharge and at 1-month follow-up, only one patient complained of localized patch hypoesthesia as reported in a simplified neurologic assessment questionnaire and neurologic examination.
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Higher Patency of Transposed Brachio-Basilic Arteriovenous Fistulas Compared to Brachio-Axillary Grafts for Hemodialysis Patients. J Vasc Access 2015; 16:486-92. [DOI: 10.5301/jva.5000433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose We compared outcomes of transposed brachio-basilic arteriovenous fistulas (BBAVF) with brachio-axillary prosthetic grafts (BAPG) for hemodialysis. Methods All consecutive patients who underwent creation of a BBAVF or a BAPG, in one of the two institutions, between January 2008 and December 2013 were retrospectively identified. We assessed functional patency and compared complication rates. Patency was also compared between one-stage and two-stage creation procedures for the BBAVF group. Results Two hundred and thirty-eight patients underwent the creation of a BBAVF (N = 136) or a BAPG (N = 102). Median follow-up was 17 months (range, 1-79). At 6, 12 and 24 months, patients in the BBAVF group had significantly higher primary patency (80%, 69%, 56% vs. 77%, 56%, 37%, respectively; p = 0.005), assisted primary patency (90%, 80%, 71% vs. 80%, 66%, 48%; p<0.0001) and secondary patency (93%, 84%, 72% vs. 94%, 87%, 62%; p = 0.006). Two-stage BBAVF had a significantly higher secondary patency (98%, 92%, 78% vs. 90%, 80%, 68%; p = 0.04) than one-stage BBAVF. The rate of infectious complications was significantly lower in the BBAVF group than in the BAPG group (0.8% vs. 6.9%; p = 0.03). Conclusions In this large cohort, BBAVF had a higher functional patency and lower rate of infectious complications than BAPG. After exhaustion of cephalic veins, we suggest creation of a BBAVF instead of BAPG, whenever anatomically feasible. The superiority of one-stage or two-stage BBAVF creation procedure must be further investigated.
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Sheldrake IL, Rowlands TE. A comparison between one-stage and two-stage procedures for the creation of brachiobasilic arteriovenous fistulas. Int J Surg 2015; 18:71-4. [PMID: 25907324 DOI: 10.1016/j.ijsu.2015.04.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 04/01/2015] [Accepted: 04/11/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Vascular access is essential to end-stage renal failure patients requiring haemodialysis. Many patients require multiple fistula formation attempts in order to gain good access, making secondary and tertiary fistula options vital. Brachiobasilic fistulas are well established, but there is little evidence to compare the different surgical techniques in creating them. This study aimed to determine the patency and complication rates associated with these procedures. METHODS Retrospective data was collected by reviewing case notes to determine fistula survival time and surgical setting. Patency, complications and required interventions were recorded for each group at three time intervals. The Kaplan-Meier method was used to calculate survival for each cohort. RESULTS 37 brachiobasilic arteriovenous fistulas were created in 35 patients. 17 fistulas were one-stage procedures; 20 fistulas were made in two stages. Survival proportions were measured as 70.6%, 58.8% and 51.5% for the one-stage procedure and 95%, 90% and 78% for the two-stage procedure at 1 month, 1 year and 2 years respectively with p = 0.0385. DISCUSSION Native brachiobasilic fistulas have advantages over prosthetic grafts. There are technical aspects which make the two-staged procedure preferable, including being more amenable to a day case surgery setting. Despite this, there is a lack of relative outcome differences in the literature, thus necessitating further work. CONCLUSION Our data suggests creation of brachiobasilic fistulas using a two-staged procedure may result in improved patency rates. Complication rates were found to be statistically equivocal, with fistuloplasties and embolectomy shown to be effective in fistula salvage.
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Affiliation(s)
- Ian L Sheldrake
- Department of Surgery, Royal Derby Hospital, Uttoxeter Road, DE22 3NE, United Kingdom.
| | - Timothy E Rowlands
- Department of Surgery, Royal Derby Hospital, Uttoxeter Road, DE22 3NE, United Kingdom
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39
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Review of Transposed Basilic Vein Access for Hemodialysis. J Vasc Access 2015; 16:356-63. [DOI: 10.5301/jva.5000381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/20/2022] Open
Abstract
Background There is ongoing debate about the use of transposed basilic vein (TBV) fistula and the choice between it and prosthetic arteriovenous graft (AVG). This paper reviews the available literature relating to TBV fistula in terms of surgical technique, patency rates, complications, access survival and compares it with prosthetic AVG for hemodialysis (HD). Methods Review of English language publications on TBV during the last two decades. Findings The rate of fistula maturation was higher in the two-stage group, although the mean diameter of the basilic vein was smaller. Dialysis via central venous catheters at time of surgery was most prevalent in patients undergoing staged procedures—14% in one-stage TBV and 43% in two-stage TBV. Several authors report 1-year cumulative patency rate of 47% to 96% and 59% to 90% for TBV and AVG, respectively. TBV provides a more cost-effective option and should be considered the next choice when primary autogenous fistulae are not possible, whereas AVGs are easier to create, can be punctured earlier and have a greater reintervention rate if the access fails. Conclusions This analysis shows that TBV has several advantages over AVG and provides a valuable access for HD but raises the need for a comparative trial between TBV and the newer generation AVGs. There is no clear superiority of the one-stage over the two-stage procedure.
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40
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Bashar K, Healy DA, Elsheikh S, Browne LD, Walsh MT, Clarke-Moloney M, Burke PE, Kavanagh EG, Walsh SR. One-stage vs. two-stage brachio-basilic arteriovenous fistula for dialysis access: a systematic review and a meta-analysis. PLoS One 2015; 10:e0120154. [PMID: 25751655 PMCID: PMC4353636 DOI: 10.1371/journal.pone.0120154] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION A brachiobasilic arteriovenous fistula (BB-AVF) can provide access for haemodialysis in patients who are not eligible for a more superficial fistula. However, it is unclear whether one- or two-stage BB-AVF is the best option for patients. AIM To systematically assess the difference between both procedures in terms of access maturation, patency and postoperative complications. METHODS Online search for randomised controlled trials (RCTs) and observational studies that compared the one-stage versus the two-stage technique for creating a BB-AVF. RESULTS Eight studies were included (849 patients with 859 fistulas), 366 created using a one-stage technique, while 493 in a two-stage approach. There was no statistically significant difference between the two groups in the rate of successful maturation (Pooled risk ratio = 0.95 [0.82, 1.11], P = 0.53). Similarly, the incidence of postoperative haematoma (Pooled risk ratio = 0.73 [0.34, 1.58], P = 0.43), wound infection (Pooled risk ratio = 0.77 [0.35, 1.68], P = 0.51) and steal syndrome (Pooled risk ratio = 0.65 [0.27, 1.53], P = 0.32) were statistically comparable. CONCLUSION Although more studies seem to favour the two-stage BVT approach, evidence in the literature is not sufficient to draw a final conclusion as the difference between the one-stage and the two-stage approaches for creation of a BB-AVF is not statistically significant in terms of the overall maturation rate and postoperative complications. Patency rates (primary, assisted primary and secondary) were comparable in the majority of studies. Large randomised properly conducted trials with superior methodology and adequate sub-group analysis are needed before making a final recommendation.
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Affiliation(s)
- Khalid Bashar
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Donagh A. Healy
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Sawsan Elsheikh
- Department of Acute Medicine, James Connolly Memorial Hospital, Dublin, Ireland
| | - Leonard D. Browne
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical, Aeronautical & Biomedical Engineering, Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
| | - Michael T. Walsh
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical, Aeronautical & Biomedical Engineering, Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
| | - Mary Clarke-Moloney
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Paul E. Burke
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Eamon G. Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Stewart R. Walsh
- Department of Surgery, National University of Ireland, Galway, Ireland
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Percutaneous Creation of Bare Intervascular Tunnels for Salvage of Thrombosed Hemodialysis Fistulas Without Recanalizable Outflow. Cardiovasc Intervent Radiol 2014; 38:894-902. [DOI: 10.1007/s00270-014-1033-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
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42
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Basilic vein transposition: review of different techniques. J Vasc Access 2014; 15 Suppl 7:S81-4. [PMID: 24817461 DOI: 10.5301/jva.5000260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2014] [Indexed: 11/20/2022] Open
Abstract
This is a review of the basilic vein procedure and changes that have evolved to improve outcomes. This includes reviewing data on the one-stage vs. two-stage technique as well as elevation for the basilic vein. The review discusses data that help the surgeon decide which technique he should evaluate.
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Nakamura T, Suemitsu K, Nakamura J. Superficialization of brachial artery as effective alternative vascular access. J Vasc Surg 2014; 59:1385-92. [DOI: 10.1016/j.jvs.2013.11.093] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/13/2013] [Accepted: 11/29/2013] [Indexed: 11/25/2022]
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44
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Hemodialysis Vascular access Construction in the Upper Extremity: A Review. J Vasc Access 2014; 16:87-92. [DOI: 10.5301/jva.5000299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose This article reviews the conventional vascular access types in the upper extremities for hemodialysis. Methods We performed a literature search for autogenous arteriovenous fistula in the upper extremities. Results The upper extremities have four potential sites: radio-cephalic or radio-basilic transposition in the forearm, and brachio-cephalic or brachio-basilic transposition in the upper arm. A pre-operative Duplex ultrasound provides valuable information regarding arterial inflow and venous outflow. The surgical approach to fistula formation and final product depends on vein diameter and length as well as proximal vein patency. The discussion focuses on access outcomes and management of common complications. Conclusions The upper extremity arteriovenous fistula is the preferred access for hemodialysis. A number of arteriovenous fistulas can be created in the upper extremities. The Duplex ultrasound identifies suitable arteries and veins for successful arteriovenous hemodialysis fistula creation. Arteriovenous hemodialysis fistula has the best long-term patency outcomes and the lowest associated morbidity and mortality. Early detection and intervention can save the fistula when complications occur.
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Vrakas G, Defigueiredo F, Turner S, Jones C, Taylor J, Calder F. A comparison of the outcomes of one-stage and two-stage brachiobasilic arteriovenous fistulas. J Vasc Surg 2013; 58:1300-4. [DOI: 10.1016/j.jvs.2013.05.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/02/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
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46
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Shibutani S, Obara H, Ono S, Kakefuda T, Kitagawa Y. Transposed brachiobasilic arteriovenous fistula. Ann Vasc Dis 2013; 6:164-8. [PMID: 23825496 DOI: 10.3400/avd.oa.13-00042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 11/13/2022] Open
Abstract
We performed transposed brachiobasilic arteriovenous fistula (TBBAVF) in 24 patients from January 2006 to August 2010. The operative time was 90-210 minutes (mean: 136 minutes). All patients had edema of an upper extremity and 2 patients had wound complications. Major complications were not seen. The primary patency rates at one and two years were 89.7% and 69.0%, respectively. The secondary patency rates at one and two years were 95.7% and 73.6%, respectively. TBBAVF has good primary and secondary patency rates with few severe complications. (English Translation of Jpn J Phlebology 2011; 22: 33-38.).
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Affiliation(s)
- Shintaro Shibutani
- Department of Vascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
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47
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Jung IM, Min SI, Kim SM, Chung JK. Clinical Outcome of Basilic Vein Transposition Arteriovenous Fistula Compared to the Forearm Loop Arteriovenous Graft. Vasc Specialist Int 2013. [DOI: 10.5758/kjves.2013.29.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- In Mok Jung
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Suh Min Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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48
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Kumano S, Itatani K, Shiota J, Gojo S, Izumi N, Kasahara H, Homma Y, Tagawa H. Strategies for the Creation and Maintenance of Reconstructed Arteriovenous Fistulas Using the Forearm Basilic Vein. Ther Apher Dial 2013; 17:504-9. [DOI: 10.1111/1744-9987.12012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | - Naoki Izumi
- Departments of Medicine; Kichijoji Asahi Hospital; Musashino; Tokyo; Japan
| | - Hitoshi Kasahara
- Departments of Medicine; Kichijoji Asahi Hospital; Musashino; Tokyo; Japan
| | - Yukio Homma
- Department of Urology; The Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Hitoshi Tagawa
- Departments of Medicine; Kichijoji Asahi Hospital; Musashino; Tokyo; Japan
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49
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Lambidis C, Galanopoulos G. Primary brachial vein transposition for hemodialysis access: Report of a case and review of the literature. Hemodial Int 2012; 17:441-3. [DOI: 10.1111/hdi.12000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Georgios Galanopoulos
- Department of Vascular Surgery“Iasò General” Hospital of Athens Athens Greece
- Department of PharmacologyMedical SchoolUniversity of Athens Athens Greece
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50
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Abstract
PURPOSE The aim of this study was to evaluate the long-term patency rate and complications associated with the use of the BBAVF in the early period. METHODS The records of all patients undergoing BBAVFs for hemodialysis access between June 2001 and June 2011 were retrospectively evaluated. We allowed the use of the BBAVF beginning two weeks after the fistula creation. The primary and secondary patencies were estimated using the Kaplan-Meier method. RESULTS A total of 44 BBAVFs were created for 41 patients. Most (73.2%) of the patients had previously been on hemodialysis. A previous history of AVG creation was noted in 36.6% and previous insertion of a catheter was reported for 72.7% of the patients, respectively. The mean time to the first cannulation of the BBAVF was 18.8 days (13-42 days). In two cases, the BBAVFs were not used. Postoperative complications were noted in 2 cases, and included prolonged arm edema and thrombosis. There was no infection of the wound or steal syndrome. The primary and secondary patency rates were 68.1% and 84.2% at 1 year, 55.0% and 80.7% at 2 years, and 38.1% and 70.1% at 5 years, respectively. CONCLUSIONS In this study, the patency rates following the early use of the BBAVFs were not inferior to the previously reported patency rates in the literature. In cases where the patients already have an inserted central catheter, the early use of the BBAVFs decreases the complications associated with catheters.
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