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Abdo EM, Abouelgreed TA, Elshinawy WE, Farouk N, Abdelaal MA, Ismail H, Ibrahim AH, Kasem SA, Aboomar AA. Use of Basilic vein in arteriovenous fistulas construction for hemodialysis access. Is it a good option alternative to prosthetic arteriovenous grafts? Arch Ital Urol Androl 2023; 95:11455. [PMID: 37435737 DOI: 10.4081/aiua.2023.11455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. PATIENTS AND METHODS A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. RESULTS Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was significantly higher in AF than in BG at 12-month followup: 77.7% vs 53.1% (p < 0.012). secondary patency rate was higher in AF than in BG at 1-year follow-up 62.5% vs 42.8% (p = 0.063), respectively. In addition, BGs required more interventions to preserve patency. CONCLUSIONS AF had higher primary, secondary and overall functional patency rates and needed fewer procedures to keep patency than BGs. Cases that need early vascular access as a result of central venous catheter complications or who have a reduced life expectancy may benefit from BGs.
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Affiliation(s)
- Ehab M Abdo
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Waleed E Elshinawy
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Nehal Farouk
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Hassan Ismail
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Amal H Ibrahim
- Department of Internal Medicine, Nephrology Unit, Faculty Medicine, Al-Azhar University, Cairo.
| | - Samar A Kasem
- Department of Internal Medicine, Nephrology Unit, Faculty Medicine, Al-Azhar University, Cairo.
| | - Ahmed A Aboomar
- Department of Internal Medicine, Nephrology Unit, Faculty Medicine, Tanta University, Tanta.
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Gan W, Shao D, Zhu F, Xu L, Tuo Y, Mao H, Wang W, Xiao W, Xu F, Chen W, Zeng X. The association between the locations of arteriovenous fistulas and patency rates: A systematic review and meta-analysis. Semin Dial 2022; 35:534-543. [PMID: 35088450 DOI: 10.1111/sdi.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The arteriovenous fistulas (AVF) continue to be the most prevalent type of vascular access for hemodialysis (HD). However, the appropriate locations of AVF are controversial. We conducted the meta-analysis to investigate the differences in patency between upper-arm and forearm AVF. METHODS PubMed, EMBASE, CENTRAL, and ISI Web of Science were searched to identify studies with differences in AVF patency at different locations. Reviewers searched the database, screened studies according to inclusion criteria, and conducted Meta-analysis. RESULTS A total of 12 studies involving 3437 patients were selected. Pooled data showed that primary patency (PP) of AVF were higher in upper-arm than forearm at 1 and 2 years (odds ratio [OR] = 1.54, p = 0.0005; OR = 2.45, p = 0.001), but the differences in cumulative patency (CP) were not statistically significant at 1 and 2 years (OR = 2.10, p = 0.08; OR = 2.16, p = 0.1). The differences in PP and CP between upper-arm and forearm AVF in patients older than 65 years were not statistically significant at 1 (OR = 1.61, p = 0.05; OR = 2.05, p = 0.17) and 2 years (OR = 3.40, p = 0.13; OR = 1.38, p = 0.16). In Asian patients, the differences in PP and CP between upper-arm and forearm AVF were not statistically significant at 1 (OR = 1.17, p = 0.41; OR = 1.02, p = 0.94) and 2 years (OR = 2.95, p = 0.08; OR = 1.23, p = 0.41). CONCLUSIONS In this study, the CP of upper-arm and forearm AVF was similar in overall population. There was no difference in PP and CP of AVF between upper-arm and forearm in Asian population or the elderly. The forearm AVF could be consider to be the first choice. for Asian patients or the elderly.
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Affiliation(s)
- Wenyuan Gan
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danni Shao
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Zhu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhong Tuo
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huihui Mao
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhe Wang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Xiao
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Xu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenli Chen
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingruo Zeng
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li YS, Ko PJ, Hsieh HC, Su TW, Wei WC. Elevation transposition method for superficialization of the basilic vein achieves better patency rate than tunnel transposition. Ann Vasc Surg 2021; 80:113-119. [PMID: 34687887 DOI: 10.1016/j.avsg.2021.08.030] [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: 03/21/2021] [Revised: 07/17/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the tunnel transposition and elevation transposition methods used for superficialization of the basilic vein in terms of complication and patency rates. METHODS This retrospective study included patients who underwent two-stage basilic vein transposition between August 2016 and December 2019. Patients were categorized into brachial-basilic fistula tunnel transposition (n=32) and elevation transposition (n=21) groups using medical records. Primary patency was defined as a conduit that remains patent without any re-intervention to maintain patency. Primary assisted patency was defined as a conduit that has undergone intervention to maintain patency but has never been thrombosed. RESULTS The distribution of baseline characteristics was similar between the two groups. Coronary artery disease was the only variable that was significantly different between the tunnel transposition and elevation transposition groups (31.1% vs. 4.8%, p=.035). The tunnel transposition group had a greater amount of blood loss (p<.001) and a longer period of hospitalization (p=.002) than the elevation transposition group. The rates of suture repair to stop bleeding from the conduit was significantly different between the tunnel transposition and elevation transposition groups (31.8% vs. 4.8%, p=.035), whereas those of other complications were not significantly different. The elevation transposition group had a significantly higher primary patency rate than the tunneled transposition group (p=.033); however, primary assisted patency was achieved in all patients (100%) in both groups. CONCLUSION Elevation transposition might be a more reliable method than tunnel transposition for superficialization of a basilic venous fistula.
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Affiliation(s)
- Ying-Sheng Li
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan.
| | - Po-Jen Ko
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Hung-Chang Hsieh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Ta-Wei Su
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Wen-Cheng Wei
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
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Güven C, Uludağ Ö. Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages. Cureus 2020; 12:e11657. [PMID: 33391896 PMCID: PMC7769500 DOI: 10.7759/cureus.11657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: The main objective of the present study is to investigate the advantages and disadvantages of proximal arteriovenous native fistulas. Hemodialysis is indispensable for patients with end-stage renal disease. For this purpose, arteriovenous fistulas (AVFs) are used. Among the native fistulas, distal radiocephalic AVF is the most preferred. However, brachiocephalic AVF (BCAVF) and brachiobasilic AVF with basilic vein transposition (basilic vein transposition arteriovenous fistula [BVTAVF]) can be used for a long time in dialysis patients whose distal vascular bed is depleted. Methods: This is a retrospective study of 117 AVFs (BCAVF and BVTAVF), in patients with end-stage chronic renal disease, that were opened with a surgical technique (2012-2018). The postoperative two-year patency rates, AVF locations, complications, and the advantages and disadvantages of these fistulas are reviewed and recorded in the light of the literature. Results: The mean age of the patients (52 men and 65 women) was 60.6 ± 13.6 years. The percentages of primary patency rates at 3, 6, 9, 12, and 24 months were 96.6%, 93.1%, 92%, 87.4%, and 82.8% in BCAVF patients, and 96.7%, 93.3%, 90%, 86.7%, and 80% in BVTAVF patients, respectively. The percentages of secondary patency rates at 6, 12, and 24 months were 100%, 93.3%, and 86.7% in BCAVF patients, and 100%, 100% and 87.7% in BVTAVF patients, respectively. Fistula thrombosis was seen as the most common complication. The early complication was bleeding/hematoma. As late complications, we encountered steal syndrome, ischemic pain in the relevant extremity, pseudoaneurysm, and high-output heart failure. Conclusion: Proximal AVFs are preferable fistulas with early maturation and high primary patency rates. We believe that relatively high complications can be avoided by opening fistulas with an appropriate surgical technique.
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Affiliation(s)
- Cengiz Güven
- Cardiac/Thoracic/Vascular Surgery, Adıyaman University Faculty of Medicine, Adıyaman, TUR
| | - Öznur Uludağ
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adıyaman, TUR
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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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Gamal WM, Mahmoud MA, Wagdy WM, Monofy AG. Comparative study between brachiobasilic and radiobasilic vascular access for dialysis in chronic renal failure patients. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.23736/s1824-4777.19.01407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Lin YC, Huang YY, Lin MY, Chiu YW, Lim LM, Hsieh CC. Long-term outcomes of lateral tunneled transposed brachiobasilic arteriovenous fistulas in elderly hemodialysis patient. J Vasc Access 2019; 20:557-562. [PMID: 30678523 DOI: 10.1177/1129729818820184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Arteriovenous fistula is recommended for the general dialysis population, but its use remains controversial in the elderly population. We evaluated the long-term outcomes of lateral tunneled transposed brachiobasilic arteriovenous fistulas in older patients who underwent hemodialysis. METHODS In this retrospective cohort study, we included patients who received a two-stage transposed brachiobasilic arteriovenous fistula in a medical center from May 2005 to January 2014. The patients were followed up from the fistula placement date until any intervention, death, failure, January 2015, or the end of the sixth year. Death and arteriovenous fistula failure during the observation period were considered as adverse outcomes, and the cause of death was identified. The cumulative patency rate was calculated using the Kaplan-Meier approach to reveal the long-term outcomes of this procedure. RESULTS Among the 66 patients who underwent surgery, the average age was 65.8 ± 13.5 years and the majority were females (62.1%). After a median follow-up of 20.6 months, 19 patients died, 12 (18.2%) received vascular intervention, and 3 experienced fistula failure. No significant difference was observed in the 6-year cumulative patency rates between younger and older adults (96.3% vs 80.3%, p = 0.58). None of the deaths during the observation period were related to bloodstream infection. CONCLUSION A two-stage lateral tunneled transposed brachiobasilic arteriovenous fistula can be applied to patients undergoing hemodialysis, regardless of age.
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Affiliation(s)
- Yen-Chin Lin
- 1 Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Yu-Ying Huang
- 1 Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Ming-Yen Lin
- 2 Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,3 Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yi-Wen Chiu
- 2 Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,3 Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Lee-Moay Lim
- 2 Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Chong-Chao Hsieh
- 4 Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung.,5 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Lee SJ, Park SH, Lee BH, Lee JW, Noh JW, Suh IS, Jeong HS. Microsurgical approach for hemodialysis access: A pilot study of Brescia-Cimino fistulas constructed under microscopic guidance. Medicine (Baltimore) 2019; 98:e14202. [PMID: 30681593 PMCID: PMC6358373 DOI: 10.1097/md.0000000000014202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The distal forearm is the preferred site for hemodialysis access. However, forearm vessels have small diameter, which may lead to complications of arteriovenous fistulas constructed at this site. Indeed, the mean patency rate of such fistulas has been reported at 65.2% (range, 56-79%) at 1 year postoperatively. In this study, we aimed to evaluate the patency rate of Brescia-Cimino arteriovenous fistulas constructed under microscopic guidance. We retrospectively evaluated the records of patients with chronic renal failure who received a Brescia-Cimino arteriovenous fistula between 2014 and 2015 for hemodialysis access. Preoperative venography and Doppler mapping were used to evaluate vein diameter at the wrist. Veins with a diameter of >2 mm were chosen. End-to-side microanastomosis was performed using Nylon #9-0 suture under microscopic guidance. Postoperatively, monthly follow-up (first with venography; with Doppler ultrasound thereafter) was conducted to detect vessel obstruction and evaluate blood flow. Six of the seven patients included in this study received hemodialysis without signs of obstruction or complications. On Kaplan-Meier survival analysis, the mean patency rate at 2 years postoperatively was 85.7%. One patient (female, 60 years) had vessel obstruction and underwent percutaneous transluminal angioplasty 3 times after receiving the arteriovenous fistula. The median follow-up duration was 41 months (range, 25-47 months). Our experience indicates that, for relatively healthy vessels with a diameter of >2 mm, Brescia-Cimino arteriovenous fistulas at the wrist can be safely constructed using microsurgical suturing under microscopic guidance, without complications such as ischemic hand syndrome or infection.
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Affiliation(s)
- Seong Joo Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Seong Hoon Park
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Byeong Ho Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Jun Won Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Jung Woo Noh
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
| | - In Suck Suh
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Hii-Sun Jeong
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
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Saratzis N, Saratzis A, Sarafidis P, Melas N, Ktenidis K, Kiskinis D. Quantitative Evaluation of the Systemic Effects of Transposed Basilic Vein to Brachial Artery Arteriovenous Fistula: A Prospective Study. J Vasc Access 2018. [DOI: 10.1177/112972980800900410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The transposed basilic vein to brachial artery arteriovenous fistula (BBAVF) constitutes an alternative autogenous vascular access (VA) site for chronic hemodialysis (HD); however, the hemodynamic effects of this procedure have not been adequately studied. The purpose of this study is to evaluate the effects of BBAVF on systemic arterial pressure, cardiac function, and upper limb ischemia (ischemic steal syndrome) utilizing reproducible quantitative methods. Methods Ten consecutive patients (eight males; mean age: 65.10 ± 2.87 yrs) scheduled to undergo a brachial-basilic vein transposition were included, excluding patients with cardiac failure. Blood flow volume at the level of the AVF, systemic arterial pressure (SAP), cardiac output (CO) and digital brachial index (DBI) were measured intra-operatively, before and after the creation of the BBAVF, and post-operatively on the 30th post-operative day and on the 3rd post-operative month. Results SAP and DBI at 30 days and 3 months post-operatively were significantly lower compared to baseline. CO at 30 days and 3 months post-operatively was significantly higher compared to baseline; however, none of the patients developed cardiac failure. DBI remained ≥0.6 at 3 months, except in one case (0.59). Blood flow volume at the level of the AVF was positively correlated with CO levels on the 30th post-operative day. Mean clinical follow-up was 12 months (range: 4–15 months). In two cases (20%) the AVF was thrombosed (4th and 10th post-operative month). Conclusion This prospective quantitative study proves that the BBAVF does impact significantly upon SAP, CO, and DBI; however, it is safe in terms of high-output cardiac failure and ischemic steal syndrome. The authors state that they do not have any commercial, proprietary, or financial interest in any products or companies described in this article.
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Affiliation(s)
- N. Saratzis
- 1st Department of Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki - Greece
| | - A. Saratzis
- 1st Department of Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki - Greece
| | - P.A. Sarafidis
- Section of Nephrology and Hypertension, 1st Department of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki - Greece
| | - N. Melas
- 1st Department of Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki - Greece
| | - K. Ktenidis
- 1st Department of Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki - Greece
| | - D. Kiskinis
- 1st Department of Surgery and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki - Greece
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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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Rego D, Nogueira C, Matos A, Almeida P, Queirós J, Silva F, Sousa C, Almeida R. Two-Stage Basilic Vein Transposition: Second Stage Results. Ther Apher Dial 2017; 22:73-78. [DOI: 10.1111/1744-9987.12601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/25/2017] [Accepted: 06/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Duarte Rego
- Angiology and Vascular Surgery Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
| | - Clara Nogueira
- Angiology and Vascular Surgery Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
| | - António Matos
- Angiology and Vascular Surgery Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
- Grupo de Estudos Vasculares; Vascular Access Centre; Porto Portugal
| | - Paulo Almeida
- Angiology and Vascular Surgery Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
- Grupo de Estudos Vasculares; Vascular Access Centre; Porto Portugal
| | - José Queirós
- Nephrology Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
| | - Fernanda Silva
- Nephrology Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
| | - Clemente Sousa
- Grupo de Estudos Vasculares; Vascular Access Centre; Porto Portugal
- Escola Superior de Enfermagem do Porto; Porto Portugal
| | - Rui Almeida
- Angiology and Vascular Surgery Department of Centro Hospitalar do Porto; Hospital de Sto. António; Porto Portugal
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Kakaei F, Hasankhani A, Seyyed-Sadeghi MS, Virani P, Asvadi T, Zarrintan S. Outcomes of relocation of basilic vein in brachiobasilic fistulas in chronic renal failure. Int J Surg 2017. [PMID: 28625819 DOI: 10.1016/j.ijsu.2017.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In patients without or with injured cephalic vein, using the basilic vein for creating arteriovenous fistula (AVF) is the best way for hemodialysis. In order to create AVF, the basilic vein should be superficialized and lateralized. This study sought to examine outcome of relocation of basilic vein in brachiobasilic fistulas in patients with chronic renal failure (CRF). METHODS We evaluated the outcome of creation of brachiobasilic fistula with transposition of basilic vein in 27 patients (14 males and 13 females with mean age of 60.03 ± 8.04 years) with CRF. The success rate and complications were recorded during the follow-up period. The fistula was regarded efficient if cannulation was feasible conveniently and a minimum flow rate of 250 ml/min for 4 h at least for 3 consecutive hemodialysis sessions through both lines was documented 30 days postoperatively. RESULTS The mean time gap between previous AVF creation or try and the relocation of basilic vein was 3.55 months. Thirty days postoperatively, 85.2% of the created AVFs were efficiently working. There were postoperative complications in 40.7% of patients including venous hypertension (14.8%), bleeding (7.4%), hematoma (7.4%) and distal paresthesia (11.1%). CONCLUSIONS Brachiobasilic AVF fistula provides a suitable option for vascular access in cases with failed previous AVF. Relocation of basilic vein for brachiobasilic AVF is technically feasible, safe and with excellent patency in short-term and complication rates are acceptable.
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Affiliation(s)
- Farzad Kakaei
- Department of General & Vascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran; Section of Organ Transplantation, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Hasankhani
- Department of General & Vascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Peyman Virani
- Department of General & Vascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tooraj Asvadi
- Department of General & Vascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Zarrintan
- Department of General & Vascular Surgery, Tabriz University of Medical Sciences, Tabriz, Iran.
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14
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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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15
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Hameed H, Aitken E, Al-Moasseb Z, Kingsmore D. Brachiobasilic fistulae: an upper limb autologous option for everyone? Ren Fail 2016; 38:636-42. [DOI: 10.3109/0886022x.2016.1150033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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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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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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18
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Kakkos SK, Tsolakis IA, Papadoulas SI, Lampropoulos GC, Papachristou EE, Christeas NC, Goumenos D, Lazarides MK. Randomized controlled trial comparing primary and staged basilic vein transposition. Front Surg 2015; 2:14. [PMID: 25973421 PMCID: PMC4413520 DOI: 10.3389/fsurg.2015.00014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/09/2015] [Indexed: 11/13/2022] Open
Abstract
Objective It is unclear if brachio-basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. Our aim was to report on a randomized controlled trial comparing these two techniques. Methods Sixteen patients with a basilic vein ≥2.5 mm were randomized into primary transposed brachio-basilic vein (TBBV) fistula (n = 9) and staged TBBV fistula (n = 7). Patients with basilic veins enlarged by previous arteriovenous fistulas were excluded. Baseline characteristics of the two study groups, including vein size, were comparable (median basilic vein diameter 3.5 mm, range 2.8–4.1 mm). The staged group had a brachio-basilic vein fistula performed first followed by the transposition procedure performed at least 6 weeks later to allow the basilic vein to enlarge. TBBV fistula maturation at 10 weeks, primary, assisted-primary, and secondary patency were the primary outcome measures. Early failures were included in the calculation of patency rates. Results Transposed brachio-basilic vein fistula maturation rate after primary procedures (3/9, 33%) was lower compared to maturation rate after staged procedures (7/7, 100%, P = 0.011, Fisher’s exact test), which led to premature termination of the trial. Time to hemodialysis [median (interquartile range)] of primary and staged procedures was 54 (51.5–113.5) days and 97 (93–126) days, respectively (P = 0.16). One-year primary and assisted-primary patency rates of primary and staged procedures were equivalent (44 vs 57%, P = 0.76 and 44 vs 71%, P = 0.29, respectively); however, there was a trend toward a better 1-year secondary patency after staged procedures (86 vs 44% for primary procedures, P = 0.09). Conclusions Among candidates for TBBV fistula with a small basilic vein, staged transposition achieves higher maturation rates compared to primary procedures, a difference reflected in long-term secondary patency. Trial registration www.ClinicalTrials.gov, identifier NCT01274117.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | - Ioannis A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras , Patras , Greece
| | | | | | - Nikolaos C Christeas
- Department of Interventional Radiology, University Hospital of Patras , Patras , Greece
| | - Dimitrios Goumenos
- Department of Nephrology, University Hospital of Patras , Patras , Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, Democritus University Hospital , Alexandroupolis , Greece
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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
- * E-mail:
| | - 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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Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae. Cardiovasc Intervent Radiol 2014; 38:887-93. [PMID: 25465063 DOI: 10.1007/s00270-014-1030-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II). METHODS We retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined. RESULTS In total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20-79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788-1,334 days). Patient age, sex, and AVF age did not affect the survival time. CONCLUSION We suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.
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Aitken EL, Jackson AJ, Hameed H, Chandramohan M, Kasthuri R, Kingsmore DB. Cephalic arch stenosis: angioplasty to preserve a brachiocephalic fistula or new brachiobasilic fistula?: a cost-effectiveness study. Ren Fail 2014; 36:1550-8. [DOI: 10.3109/0886022x.2014.949763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Brachiobasilic Fistula Formation – Single versus Two Stage Procedure. Eur J Vasc Endovasc Surg 2013; 45:689-92. [DOI: 10.1016/j.ejvs.2013.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 03/03/2013] [Indexed: 11/20/2022]
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Paulson KA, Gordon V, Flynn L, Lorelli D. Modified two-stage basilic vein transposition for hemodialysis access. Am J Surg 2011; 202:184-7. [DOI: 10.1016/j.amjsurg.2010.06.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 11/17/2022]
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Reynolds TS, Zayed M, Kim KM, Lee JT, Ishaque B, Dukkipati RB, Kaji AH, de Virgilio C. A comparison between one- and two-stage brachiobasilic arteriovenous fistulas. J Vasc Surg 2011; 53:1632-8; discussion 1639. [DOI: 10.1016/j.jvs.2011.01.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 01/19/2011] [Accepted: 01/21/2011] [Indexed: 11/25/2022]
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Veeramani M, Vyas J, Sabnis R, Desai M. Small incision basilic vein transposition technique: a good alternative to standard method. Indian J Urol 2011; 26:145-7. [PMID: 20535307 PMCID: PMC2878432 DOI: 10.4103/0970-1591.60466] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
End-stage renal disease is a significant health problem. The primary use of the autogenous arteriovenous access is recommended by NKF-DOQI (National Kidney Foundation-Dialysis Outcomes Quality Initiative) guidelines. Though basilic vein transposition is well established in multiple failed fistulae's and obese patients, it requires large incision and morbidities like edema and infection. To avoid such compilations we, at our institution, adopted a small incision technique using two small 3-4 cm incisions. This method is inspired by videoendoscopic minimally invasive method used to dissect the basilic vein, thus avoiding extensive dissection and related morbidities.
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Affiliation(s)
- Muthu Veeramani
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gugarat - 387 001, India
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Abstract
Purpose The hemodialysis population is constantly expanding as patients on dialysis have increased longevity and the number of kidneys available for transplantation remains static (1). After radiocephalic and brachiocephalic fistulas have been exhausted the use of the autologous brachiobasilic fistula (BBAVF) should be considered prior to use of a synthetic graft. We present our single center experience of 140 brachiobasilic fistulas in a five-year period and examine any factors that influence patency and long-term function. Methods Patients who had undergone formation of a BBAVF between January 2004 and January 2009 were identified; a review of all case notes and databases was undertaken. Details on demographics, cause of renal failure, co-morbidities (including diabetes, cardiac morbidity, hypertension, peripheral vascular disease), dialysis status at the time of fistula creation, hemoglobin, anti-coagulation regimens, and complications from surgery were recorded. Results Patency (defined as use of AVF for dialysis) was 83% at 3 months, 77% at 6 months, and 69% at 12 months. Length of patency ranged from 0 to 1918 days (at study cut-off) with a mean patency of 532 days. Factors found to significantly affect fistula patency included age over 60 ( P=<0.001) and presence of peripheral vascular disease ( P=0.048). Conclusions Our brachiobasilic fistula patency rates are comparable with published literature and other fistulas. Within our population patient variables including age over 60 and the presence of peripheral vascular disease are associated with worse outcomes as would be expected. In spite of these factors we feel the brachiobasilic fistula is an excellent option for patients with more challenging access and should certainly be undertaken prior to the use of prosthetic grafts.
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Dukkipati R, de Virgilio C, Reynolds T, Dhamija R. Outcomes of Brachial Artery-Basilic Vein Fistula. Semin Dial 2011; 24:220-30. [DOI: 10.1111/j.1525-139x.2011.00860.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Great Saphenous Vein Transposition to the Forearm for Dialysis Vascular Access; An under used Autologous Option? J Vasc Access 2011; 12:354-7. [DOI: 10.5301/jva.2011.8384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose The recommended site for the next autologous vascular access in patients without suitable cephalic vein for fistula formation is basilic vein transposition. This study aims to compare outcomes from great saphenous vein transpositions to the forearm with that of basilic vein transposition. Comparison is reported in terms of primary and secondary patency, intervention, and complication rates in our unit. Method A retrospective search of a prospectively maintained vascular database identified 24 consecutive patients undergoing great saphenous vein transposition (GSVT) and 34 consecutive patients having basilic vein transposition (BVT) were included for comparison. Primary and secondary patency details were obtained from hospital case notes and dialysis unit review records. Patency was studied using a Kaplan Meier analysis and compared using log rank testing. Results No significant difference was identified in primary or secondary patency between the procedures ( P=0.745). Primary patency at 6, 12 and 24 months: for GSVT this was 62%, 41%, and 20%; for BVT this was 44%, 32%, and 15% respectively. Secondary patency at 6, 12, and 24 months; for GSVT this was 75%, 50%, and 41%; for BVT this was 65% respectively. Requirements for intervention were similar between groups. Complications were more common in the BVT group. Conclusion Acceptable patency rates can be achieved using GSVT, thus adding another autologous option for upper limb dialysis access. Our results would suggest GSVT could be performed prior to BVT as the basilic vein may benefit from prior partial arterialization and can subsequently be used if GSVT fails.
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Son HJ, Min SK, Min SI, Park YJ, Ha J, Kim SJ. Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula. J Vasc Surg 2010; 51:667-72. [DOI: 10.1016/j.jvs.2009.09.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 09/04/2009] [Accepted: 09/05/2009] [Indexed: 11/28/2022]
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Kakkos SK, Haddad GK, Weaver MR, Haddad RK, Scully MM. Basilic vein transposition: what is the optimal technique? Eur J Vasc Endovasc Surg 2010; 39:612-9. [PMID: 20172751 DOI: 10.1016/j.ejvs.2010.01.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 01/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare the outcome of the one-stage basilic vein transposition (BVT) fistula with a modified, two-stage technique. DESIGN Retrospective case-controlled study, performed in an academic centre. MATERIAL A total of 173 candidates for BVT fistula (87 males, mean age 61 years). METHODS In one-stage BVT, the basilic vein is mobilised through a single incision, placed inside an anterolateral arm tunnel and anastomosed with the brachial artery. In two-stage procedures, the fistula-arterial anastomosis is created first, followed by the second stage, after fistula maturation several weeks later, when the basilic vein is mobilised through two skip incisions, transected near the anastomosis, placed inside an anterolateral arm tunnel and reanastomosed. Morbidity and fistula maturation rate were the main outcome measures. RESULTS In one-stage BVT (n=76), the incidence of venous hypertension, wound haematomas and all complications (17%, 13% and 43%, respectively) was significantly higher than in two-stage procedures (n=98) (4%, p=0.004, 3%, p=0.012 and 11%, p<0.001, respectively). Time (68 days) to fistula use was significantly decreased in one-stage BVT than in two-stage procedures (132 days, p<0.001) but failure to mature rate was equivalent (15% vs. 18%, p=0.49). CONCLUSIONS Our results indicate that the two-stage BVT fistula through two skip-arm incisions is superior to the established one-stage procedure in terms of less morbidity but at the cost of a second operation and longer time to access use. Further research comparing these two techniques is necessary. Until this issue is resolved, an individualised approach is suggested.
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Affiliation(s)
- S K Kakkos
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, K-8, 2799 W Grand Boulevard, Detroit, MI 48202, USA
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Two-stage basilic vein transposition-a new approach for pediatric dialysis access. J Pediatr Surg 2010; 45:177-84; discussion 184. [PMID: 20105601 DOI: 10.1016/j.jpedsurg.2009.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Accepted: 10/06/2009] [Indexed: 11/23/2022]
Abstract
PURPOSE The fistula first initiative has led to increased efforts to create arteriovenous fistulas (AVFs) as primary dialysis access. Two-stage basilic vein transposition (BVT) allows maturation of smaller veins, often a limiting factor in the pediatric population, before elevation and use. We sought to determine whether using 2-stage BVT improves maturation, use, and patency compared with other AVFs, including arteriovenous (AV) grafts. METHODS Thirty-one patients underwent AV access creation between 1997 and 2008. Data were collected on types of access, maturation, complications, and patency. RESULTS Forty-two AV access procedures were performed: 15 (36%) 2-stage BVT, 13 (31%) 1-stage BVT, 6 (14%) radiocephalic, 3 (7%) brachiocephalic, 1 (2%) brachiobrachial, and 4 (10%) AV grafts. Follow-up averaged 20.4 +/- 3.2 months for 2-stage BVT and 47.9+/-4.1 months for other AVFs (P < .001). All 2-stage BVT matured compared with 52% (14/27) of other AVFs (P = .001). More 2-stage BVTs (87%) were used for dialysis than other AVFs (48%, P = .024). Fistula failure occurred in 7% 2-stage BVT compared with 59% other AVFs (P = .001). One-year patency rates were 91% for 2-stage BVT vs 47% for other AVFs (P = .003). CONCLUSIONS Rates of fistula maturation, use, and patency are higher for 2-stage BVT with lower rates of failure. Two-stage BVT shows great promise as the preferred approach to creation of AVF in pediatric patients, especially those with smaller veins.
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Glass C, Porter J, Singh M, Gillespie D, Young K, Illig K. A Large-Scale Study of the Upper Arm Basilic Transposition for Hemodialysis. Ann Vasc Surg 2010; 24:85-91. [DOI: 10.1016/j.avsg.2009.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 05/12/2009] [Accepted: 05/21/2009] [Indexed: 11/25/2022]
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Hashemi H, Sheridan MJ, Ford B. Selective two-stage basilic and cephalic vein transpositions can significantly improve the rate of fistula construction. Int J Angiol 2009; 18:129-34. [PMID: 22477513 DOI: 10.1055/s-0031-1278339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Modified proximal radial artery arteriovenous fistula (MPRAVF) can be used to improve the success and patency of basilic vein transposition (BVT) and cephalic vein transposition (CVT). In the present study, surgical experience with patients requiring a two-stage BVT or CVT using MPRAVF as the first stage was reviewed. METHODS All two-stage BVTs and CVTs performed between September 2004 and October 2006 were retrospectively reviewed. The median follow-up for this cohort was 23.7 months. One-year secondary patency of all transpositions was assessed. RESULTS Two hundred nineteen MPRAVFs were constructed. Twelve MPRAVFs failed and underwent a second procedure. Ninety-eight patients required no further procedures and their upper arm cephalic vein was matured and used for dialysis. Of 121 patients whose MPRAVFs were functioning but unusable due to their depth, 87 underwent BVT and 34 underwent CVT. The Kaplan-Meier one-year secondary patencies (± standard error) for BVTs and CVTs were 0.90±0.03 and 0.82±0.06, respectively. At one year, 87% of all transpositions remained patent. CONCLUSIONS Use of MPRAVF as the first stage of a two-stage BVT or CVT can significantly improve the patency rate of autogenous hemodialysis access placement beyond the 66% set forth by the Fistula First guidelines.
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Hollenbeck M, Mickley V, Brunkwall J, Daum H, Haage P, Ranft J, Schindler R, Thon P, Vorwerk D. Gefäßzugang zur Hämodialyse. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11560-009-0281-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Harper S, Goncalves I, Doughman T, Nicholson M. Arteriovenous Fistula Formation using Transposed Basilic Vein: Extensive Single Centre Experience. Eur J Vasc Endovasc Surg 2008; 36:237-241. [DOI: 10.1016/j.ejvs.2008.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 02/23/2008] [Indexed: 10/22/2022]
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Chemla ES, Morsy MA. Is basilic vein transposition a real alternative to an arteriovenous bypass graft? A prospective study. Semin Dial 2008; 21:352-6. [PMID: 18564966 DOI: 10.1111/j.1525-139x.2008.00449.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Basilic vein transpositions (BVTs) are considered to be superior to arteriovenous bypass grafts (AVGs). However, for the most part studies comparing BVTs to AVGs have been retrospective in design and without a set follow-up protocol. In this analysis, data were prospectively collected from patients with either a BVT or a brachio-axillary AVG. When all other native options were exhausted a BVT was performed if the vein had a diameter of 3 mm. All patients had bimonthly measurements of access inflow and recirculation using ultrasound dilution and were followed up for 2 years. Of 76 patients, 34 had a BVT and 42 an AVG (p > 0.05). BVT group: 12 were male, 22 female, the mean age was 62 and 26% were diabetic. AVG group: 22 were male, 20 female, the mean age was 57 and 56% were diabetic. The maturation delay was higher in the BVT group (6 weeks vs. 2 weeks). For the BVT and AVG groups, at 6, 12 and 24 months, respectively, primary patency was 90% vs. 76% (p < 0.05), 73% vs. 61% and 69% vs. 54% (p > 0.05). Assisted primary patency was 100% vs. 90% (p = 0.1201), 96% vs. 56% and 74% vs. 40% (p < 0.001). Secondary patency was 100% vs. 83%, 93% vs. 70% (p < 0.025) and 85% vs. 62% (p < 0.01). In the BVT group, 18 patients had 32 interventions for a total cost of $127,800, while in the AVG group, 27 patients had 54 interventions for a total cost of $227,300. This is the first prospective study to confirm that BVTs were cost effective and associated with better outcomes when compared with AVGs.
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Affiliation(s)
- Eric S Chemla
- St George's Healthcare NHS Trust, London, United Kingdom.
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Moossavi S, Tuttle AB, Vachharajani TJ, Plonk G, Bettmann MA, Majekodunmi O, Russell GB, Regan JD, Freedman BI. Long-term outcomes of transposed basilic vein arteriovenous fistulae. Hemodial Int 2008; 12:80-4. [PMID: 18271846 DOI: 10.1111/j.1542-4758.2008.00245.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The need for reliable, long-term hemodialysis vascular access remains critical. To determine the long-term outcomes of transposed basilic vein arteriovenous fistulae (BVT) and their comparability with other vascular accesses, we determined retrospectively the primary and secondary patency rates in 58 BVT and in a total of 58 arteriovenous fistulae (AVF) and arteriovenous grafts (AVG) at a single center. Fifty-eight BVT were placed in 57 individuals, 69% after prior vascular access failure. Ten BVT failed before initial use and 2 patients expired with functioning accesses before dialysis initiation. In all 58 BVT, 46.8+/-10.8% functioned at 3 years, with median survival 30.8 months. Limiting analyses to the 46 BVT that were ultimately accessed, 3-year primary and secondary patency rates were 38.3+/-7.7% and 56.5+/-12.6%, respectively. Lower ejection fraction (p=0.054) and greater numbers of prior permanent dialysis catheters (p=0.005) were present in those with failed BVT. Compared with AVF, BVT had similar 3-year primary and secondary patency rates. The secondary patency rate was significantly better for BVT vs. AVG over the observation period; at 3 years, the rates were 56.5+/-12.6% vs. 9.1+/-6.0% (p=0.002), respectively. Basilic vein arteriovenous fistulae are valuable hemodialysis accesses. Although nearly 20% of newly placed BVT will not function before first use, those that are functional have median survivals exceeding 6 years, and 38% will not require intervention within 3 years of initial use.
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Affiliation(s)
- Shahriar Moossavi
- Department of Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.
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Kakkos SK, Andrzejewski T, Haddad JA, Haddad GK, Reddy DJ, Nypaver TJ, Scully MM, Schmid DL. Equivalent secondary patency rates of upper extremity Vectra Vascular Access Grafts and transposed brachial-basilic fistulas with aggressive access surveillance and endovascular treatment. J Vasc Surg 2008; 47:407-14. [PMID: 18155874 DOI: 10.1016/j.jvs.2007.09.061] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 09/20/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
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A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg 2008; 47:395-401. [DOI: 10.1016/j.jvs.2007.09.063] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 09/26/2007] [Accepted: 09/29/2007] [Indexed: 11/23/2022]
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Brachial versus basilic vein dialysis fistulas: A comparison of maturation and patency rates. J Vasc Surg 2008; 47:402-6. [DOI: 10.1016/j.jvs.2007.10.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 10/16/2007] [Accepted: 10/17/2007] [Indexed: 11/20/2022]
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Weale AR, Bevis P, Neary WD, Lear PA, Mitchell DC. A comparison between transposed brachiobasilic arteriovenous fistulas and prosthetic brachioaxillary access grafts for vascular access for hemodialysis. J Vasc Surg 2007; 46:997-1004. [DOI: 10.1016/j.jvs.2007.07.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 06/25/2007] [Accepted: 07/19/2007] [Indexed: 11/24/2022]
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Abstract
Surgery for hemodialysis access is the most commonly performed vascular surgical operation in the United States, predominantly because of a steady increase in the prevalence of end-stage renal disease. Multiple studies have confirmed the improved patency rate and lower infection rates for native arteriovenous fistulae compared with prosthetic arteriovenous grafts. In formulating a strategy for successful dialysis access a comprehensive approach should be undertaken. The preoperative planning, as with any surgical procedure, is the most important aspect, followed by the postoperative maintenance of the access.
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Affiliation(s)
- Niten Singh
- Vascular and Endovascular Surgery Madigan Army Medical Center, 9040-A Fitzsimmons Avenue, Tacoma, WA 98431, USA.
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45
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Abstract
Transposed arteriovenous fistulae have been utilized in clinical scenarios where simple arteriovenous fistulae have failed or their construction was not possible for anatomical reasons. Despite variability in published reports, transposed arteriovenous fistulae have acceptable patency rates and outperform prosthetic arteriovenous grafts in patency, frequency of intervention to maintain patency, and complication rates.
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Affiliation(s)
- Alik Farber
- Section of Vascular Surgery, Boston University Medical Center, Boston, MA 02118, USA.
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Kayacioglu I, Baysal A, Ates M, Vural U, Balci AY, Saskin H, Celik A, Alkan RP, Kanca A. The Effect of the Keyhole Technique on Diabetic Patients Undergoing Autologous Brachiobasilic Transposition of an Arteriovenous Fistula. Heart Surg Forum 2007; 10:E147-52. [PMID: 17597041 DOI: 10.1532/hsf98.20061157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Our aim was to investigate the efficiency of the keyhole transposed brachiobasilic technique in patients with diabetes mellitus and compare the effect of different arteriovenous fistula techniques on the development of complications. MATERIALS AND METHODS Thirty-eight diabetic, chronic renal failure patients (group 1) had transposed brachiobasilic arteriovenous fistula creations, and 49 diabetic patients (group 2) had other types of fistula creations and histories of multiple fistula attempts. The 2 groups were compared for age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, arteriovenous fistula patency, and possible complications. RESULTS The 2 groups were not different statistically regarding the demographic data including age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, and mean operation time. The median follow-up after surgery in both groups was 8 months. The primary patency in group 1 was 97.4% in the early period (6 weeks after surgery) and 94.7% in the late period (mean duration of 8 months after surgery). In the second group, these rates were 73% and 62%, respectively (P < .05). The secondary patency rates were 84.2% in group 1 and 53% in group 2 (P < .05). In group 2, the primary and secondary patencies of brachiocephalic and radiocephalic fistulas were significantly lower than the patencies of group 1. The incidence of complications was significantly less in group 1 than in group 2 (P < .05). CONCLUSION Although the groups were small in size, the success rate with the keyhole transposed brachiobasilic technique in patients with diabetes was extremely gratifying, and this report can be considered to document the first attempt of a hemodialysis-access procedure.
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Affiliation(s)
- Ilyas Kayacioglu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
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Francis DMA, Lu Y, Robertson AJ, Millar RJ, Amy J. TWO-STAGE BRACHIOBASILIC ARTERIOVENOUS FISTULA FOR CHRONIC HAEMODIALYSIS ACCESS. ANZ J Surg 2007; 77:150-5. [PMID: 17305990 DOI: 10.1111/j.1445-2197.2006.03996.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many haemodialysis patients are unable to have or maintain distal upper limb arteriovenous (AV) fistulas because of inadequate veins or arteries and therefore require more proximal access. We have reviewed our experience with a two-stage brachiobasilic AV haemodialysis fistula fashioned in the arm. METHODS Ninety-one brachiobasilic AV fistulas were fashioned in 87 patients between August 1999 and October 2004. Four AV fistulas failed because of early thrombosis. The second stage 'superficialization' was carried out at a median (range) of 73 days (32-1827 days) after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the anteromedial aspect of the arm and transposing it beneath the skin incision. RESULTS Primary and secondary patency rates were 87 and 89%, respectively, at 1 year and 78 and 84%, respectively, at 2 years. Early complications included infection (3%) and haemorrhage (4%) and late complications included thrombosis (15%) and stenosis (14%). CONCLUSION The two-stage superficialized brachiobasilic AV fistula described in this article has good patency. The operative techniques are straightforward, have relatively low complication rates and result in a large-diameter fistula on the anteromedial aspect of the arm allowing easy and painless cannulation for haemodialysis.
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Affiliation(s)
- David M A Francis
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Austalia.
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Abstract
Vascular access thrombosis in the hemodialysis patient leads to significant cost and morbidity. Fistula patency supersedes graft patency, therefore obtaining a mature functioning fistula in patients approaching end-stage renal disease (ESRD) by early patient education and referral needs to be practiced. Current methods to maintain vascular access patency rely on early detection and radiologic or surgical prevention of thrombosis. Study of thrombosis biology has elucidated other potential targets for the prophylaxis of vascular access thrombosis. The goal of this review is to examine the current available methods for vascular access thrombosis prophylaxis.
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Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, University of Texas Southwestern Medical School, VA North Texas Health Care System, Dallas, Texas 75216, USA.
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Wang KL, Li SY, Chuang CL, Chen TW, Chen JY. Subfascial Hematoma Progressed to Arm Compartment Syndrome due to a Nontransposed Brachiobasilic Fistula. Am J Kidney Dis 2006; 48:990-2. [PMID: 17162155 DOI: 10.1053/j.ajkd.2006.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 08/22/2006] [Indexed: 11/11/2022]
Abstract
Vascular access-associated compartment syndrome is reported rarely in hemodialysis patients. A 62-year-old female hemodialysis patient experienced left-arm compartment syndrome caused by a nontransposed brachiobasilic arteriovenous fistula. A subfascial hematoma that developed because of perforation of the posterior wall of the basilic vein was not detected by Doppler ultrasound initially, and subsequent heparinized hemodialysis caused progression of the hematoma. Neuromuscular sequelae were prevented by performing an emergent fasciotomy, and transposition of the arterialized basilic vein was performed later to prevent similar complications in the future. This case report shows the risk for the occurrence of such a devastating complication if the nontransposed brachiobasilic fistula is used for hemodialysis vascular access.
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Affiliation(s)
- Kang-Ling Wang
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Tordoir JHM, Keuter X, Planken N, de Haan MW, van der Sande FM. Autogenous Options in Secondary and Tertiary Access for Haemodialysis. Eur J Vasc Endovasc Surg 2006; 31:661-6. [PMID: 16297643 DOI: 10.1016/j.ejvs.2005.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The world's haemodialysis population is growing rapidly so that in 2006, some 1.5 million interventions will be needed for access placement, revision and maintainance. Secondary and tertiary arteriovenous fistulas are becoming an integral part of vascular access especially in the elderly, comorbid population. METHODS Venous conduits may have a more favourable outcome with fewer complications and revisions in comparison with accesses using prosthetic implants. Innovative surgical techniques, including vein transposition, translocation and elevation may add to this philosophy of creating exclusively autogenous vascular access.
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Affiliation(s)
- J H M Tordoir
- Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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