1
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Alnahhal KI, Rowse J, Kirksey L. The challenging surgical vascular access creation. Cardiovasc Diagn Ther 2023; 13:162-172. [PMID: 36864962 PMCID: PMC9971302 DOI: 10.21037/cdt-22-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
With the increasing life expectancy of patients with end-stage kidney disease, the creation and maintenance of hemodialysis vascular access are becoming more challenging. A comprehensive patient evaluation including a complete history, physical examination, and ultrasonographic vessel assessment is the foundation of the clinical evaluation. A patient-centered approach acknowledges the myriad of factors that impact the selection of optimal access for the distinct clinical and social circumstance of each patient. An interdisciplinary team approach involving various healthcare providers in all stages of hemodialysis access creation is important and associated with better outcomes. While patency is considered the most important parameter in most vascular reconstructive scenarios, the ultimate determinant of success in vascular access for hemodialysis is a circuit that allows consistent and uninterrupted delivery of the prescribed hemodialysis. The best conduit is one that is superficial, easily identified, straight, and of a large caliber. Individual patient factors and skill level of the cannulating technician also play a crucial role in the initial success and maintenance of vascular access. Special attention should be considered in dealing with more challenging groups such as the elderly population where the newest vascular access guidance from The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative will be transformative. The current guidelines recommend monitoring the vascular access by regular physical and clinical assessments, however, inadequate evidence is available to support routine ultrasonographic surveillance for improving access patency.
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Affiliation(s)
- Khaled I Alnahhal
- Department of Vascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jarrad Rowse
- Department of Vascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Kirksey
- Department of Vascular Surgery, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Superficialization methods of arteriovenous fistula in obese patients: a review of the literature: Arteriovenous fistula in obese patients. Ann Vasc Surg 2021; 83:313-327. [PMID: 34954375 DOI: 10.1016/j.avsg.2021.12.013] [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: 08/16/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The creation of an arteriovenous fistula (AVF) in obese patients with end-stage-renal-disease, might not lead to a successful hemodialysis session, partly due to excess adipose tissue overlapping the enlarged vein. This review summarizes the available evidence on superficialization methods in studies dealing with obese patients. METHODS An English-language literature search was undertaken in the MEDLINE/SCOPUS databases looking for publications that described procedures of salvaging autologous arteriovenous access in upper extremities of obese patients. Perioperative outcomes including technical and clinical success, mean vein depth reduction, wound complications and patency rates were compared within all identified techniques. RESULTS We identified 12 prospective and 8 retrospective studies. A total of 1149 patients with a mean age 57.2 (range: 49-68) years and a mean BMI 35.8 (range: 28.2-40.8) kg/m2 underwent mainly radial-cephalic and brachial-cephalic AVF superficialization procedures [transposition, 54%; elevation, 11.1%; lipectomy, 26.1%; liposuction, 2.4%; implantation of a venous window needle guide device, 6.4%]. Technical success was similar between all methods (≥ 96%). However, successful cannulation was lower after liposuction and elevation (81.5 and 78.1% respectively). Transposition achieved lower mean vein depth reduction and clinical success when compared with lipectomy (4.9mm vs 8.8mm and 90% vs 92,7% respectively). Transposition and liposuction had the lowest and highest complication rate respectively (1.6% vs 40.8%). Primary and secondary patency rates were lower with liposuction (51.8 and 76.6% respectively), while lipectomy and elevation achieved the highest primary patency rates (68.3% and 71.6% respectively) at 12 months. CONCLUSIONS In obese patients, all superficialisation techniques report high technical success rates. Although limited by the design of individual published studies and lack of a standard for reporting outcomes, these results lead to satisfactory postoperative and early outcomes. In aggregate, lipectomy and transposition are more clinically effective and more durable procedures.
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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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Özhan A, Baştopçu M, Memetoğlu ME, Kehlibar T, Ketenci B. Consideration of vein diameter in brachiobasilic arteriovenous fistula technique. Ther Apher Dial 2021; 26:252. [PMID: 33826229 DOI: 10.1111/1744-9987.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Abdulkerim Özhan
- Department of Cardiovascular Surgery, Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Murat Baştopçu
- Department of Cardiovascular Surgery, Tatvan State Hospital, Bitlis, Turkey
| | - Mehmet Erdem Memetoğlu
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tamer Kehlibar
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Bülend Ketenci
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Ozhan A, Memetoglu ME, Kehlibar T, Bastopcu M, Yilmaz M, Karakaya C, Guler E, Ketenci B. Transposition of brachiobasilic arteriovenous fistulas: One-stage or two-stage technique and factors affecting the early maturation. Ther Apher Dial 2020; 25:636-641. [PMID: 33244889 DOI: 10.1111/1744-9987.13610] [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: 07/23/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
The brachiobasilic transposition (BBT) arteriovenous fistula (AVF) is a valuable option especially for dialysis patients with previously failed vascular access. We aim to report factors affecting the maturation of BBT-AVF created with either one-stage or two-stage technique. BBT-AVF procedures between January 2015 and May 2019 by a dedicated vascular access team were investigated retrospectively. A total of 122 patients (63 males, 59 females), with 6 to 12 weeks of follow-up after the BBT-AVF procedure were included in the study. Patients of one-stage and two-stage techniques were compared for maturation rates. Patients with successful and failed maturation were compared for baseline characteristics and anatomic factors. Of 122 BBT-AVF procedures, 54 were created with the one-stage and 68 were created with the two-stage technique. The mean age of the patients was 58.2 ± 13.8, the mean brachial artery and basilic vein diameters were 3.91 ± 1.02 mm, and 3.39 ± 1.16 mm. Of 122 included patients, 88 (72.1%) had mature AVFs at follow-up. The AVF maturation rates were similar between the one- and two-stage groups (70.4% vs 73.5%; P = .699). Lower age (62.8 ± 12.5 vs 56.5 ± 13.9; P = .023) and greater brachial artery diameter (3.09 ± 0.84 mm vs 4.23 ± 1.76 mm; P < .048) were the only factors affecting the AVF maturation in univariate analysis. Gender, extremity side, diabetes mellitus, hypertension, and targeted vein diameter were not found to affect the AVF maturation (P = .301, P = .084, P = .134, P = .858, P = .127). Target artery diameter (P = .049) was the only significant factor affecting BBT-AVF maturation in multivariate analysis. One-stage and two-stage BBT-AVFs are similar in terms of maturation rates. Targeted artery diameter was the only factor important in BBT-AVF maturation in our study group. The two-stage technique can be preferred considering smaller incision size and lower complication rate in patients with suitable anatomy.
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Affiliation(s)
- Abdulkerim Ozhan
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye Cd No 13, Istanbul, Turkey
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Vrtovsnik F, Brunet P, Chauveau P, Juillard L, Lasseur C, Mercadal L. [Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults]. Nephrol Ther 2020; 16:376-386. [PMID: 33139227 DOI: 10.1016/j.nephro.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 11/16/2022]
Affiliation(s)
- François Vrtovsnik
- Service de néphrologie, Nord-université de Paris, Inserm U1149, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Philippe Brunet
- Service de néphrologie, centre de néphrologie et transplantation rénale, université Aix-Marseille, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 05, France
| | - Philippe Chauveau
- Aurad-Aquitaine, 2, allée des Demoiselles, 33171 Gradignan cedex, France
| | - Laurent Juillard
- Service de néphrologie, Inserm U1060, université de Lyon, hôpital Herriot, place d'Arsonval, Lyon cedex 03, France
| | - Catherine Lasseur
- Aurad-Aquitaine, 2, allée des Demoiselles, 33171 Gradignan cedex, France
| | - Lucile Mercadal
- Département uro-néphrologie transplantation rénale, Sorbonne université, Inserm U1018, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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7
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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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8
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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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Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, Al Shakarchi J, Berger P, Bolignano D, Cassidy D, Chan TY, Dhondt A, Drechsler C, Ecder T, Finocchiaro P, Haller M, Hanko J, Heye S, Ibeas J, Jemcov T, Kershaw S, Khawaja A, Labriola L, Lomonte C, Malovrh M, Marti I Monros A, Matthew S, McGrogan D, Meyer T, Mikros S, Nistor I, Planken N, Roca-Tey R, Ross R, Troxler M, van der Veer S, Vanholder R, Vermassen F, Welander G, Wilmink T, Koobasi M, Fox J, Van Biesen W, Nagler E. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34:ii1-ii42. [PMID: 31192372 DOI: 10.1093/ndt/gfz072] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | | | | | - Jan Tordoir
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Davide Bolignano
- Institute of Clinical Physiology of the Italian National Council of Research, Reggio Calabria, Italy.,ERBP, guideline development body of ERA-EDTA, London, UK
| | | | | | | | - Christiane Drechsler
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Würzburg, Würzburg, Germany
| | - Tevfik Ecder
- Istanbul Bilim University School of Medicine, Istanbul, Turkey
| | | | - Maria Haller
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | - Sam Heye
- Jessa Hospital, Hasselt, Belgium
| | - Jose Ibeas
- Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Aurangzaib Khawaja
- Queen Elisabeth Hospital, University Hospitals Birmingham, West Midlands Deanery, Birmingham, UK
| | | | - Carlo Lomonte
- Miulli General Hospital, Acquaviva delle Fonti, Italy
| | | | | | | | | | | | | | - Ionut Nistor
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Medicine and Pharmacy, Iasi, Romania
| | - Nils Planken
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ramon Roca-Tey
- Hospital de Mollet, Fundació Sanitària Mollet, Barcelona, Spain
| | - Rose Ross
- Ninewells Hospital Scotland, Dundee, UK
| | | | | | | | | | | | - Teun Wilmink
- Heart of England NHS foundation Trust, Birmingham, UK
| | - Muguet Koobasi
- ERBP, guideline development body of ERA-EDTA, London, UK
| | - Jonathan Fox
- ERBP, guideline development body of ERA-EDTA, London, UK.,University of Glasgow, UK
| | - Wim Van Biesen
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
| | - Evi Nagler
- ERBP, guideline development body of ERA-EDTA, London, UK.,Ghent University Hospital, Ghent, Belgium
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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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11
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Regarding "A systematic review and meta-analysis of one-stage versus two-stage brachiobasilic arteriovenous fistula creation". J Vasc Surg 2018; 68:1618-1619. [PMID: 30360855 DOI: 10.1016/j.jvs.2018.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/26/2018] [Indexed: 11/20/2022]
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12
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Wee IJY, Mohamed IH, Patel A, Choong AMTL. Reply. J Vasc Surg 2018; 68:1619-1620. [PMID: 30360857 DOI: 10.1016/j.jvs.2018.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ian Jun Yan Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ismail Heyder Mohamed
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; General Surgery and Renal Transplant, London Deanery, Royal London Hospital, London, United Kingdom
| | - Amit Patel
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Stem Cell Transplantation and Haemato-Oncology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Stem Cell Transplantation and Haemato-Oncology, Royal Liverpool University Hospital, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Division of Vascular Surgery, National University Heart Centre, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Kakkos SK, Lampropoulos GC, Nikolakopoulos KM, Tsolakis IA, Papadoulas SI, Papachristou EC, Goumenos D, Lazarides MK. A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas. Vasc Specialist Int 2018; 34:51-60. [PMID: 30310807 PMCID: PMC6175573 DOI: 10.5758/vsi.2018.34.3.51] [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] [Received: 06/20/2018] [Revised: 08/06/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose There is currently debate if brachio-basilic vein fistula (BBVF) should be performed as a one-stage or two-stage procedure. The aim of the present study was to perform a systematic review and meta-analysis on BBVF staging. Materials and Methods On February 25, 2016, a search for randomized-controlled trials (RCTs) on BBVF procedures was performed in MEDLINE and Scopus databases. Meta-analyses were performed with fixed-effect or random-effects models as appropriate with risk ratios (RRs). The primary efficacy and safety outcome measures were BBVF maturation and development of complications, respectively. Specific types of complications, including loss of functional secondary patency and long-term complications were all secondary outcome measures. Results We identified three RCTs reporting on 126 patients. Maturation failure of two-stage BBVFs (3/47, 6.4%) was less frequent than one-stage BBVFs (16/79, 20.3%; RR, 0.27; P=0.02). Complication rates of two-stage and one-stage BBVFs were similar (RR, 0.80; P=0.54), but on sensitivity analysis these were less likely to occur with two-stage BBVFs (37% vs. 69% for one-stage BBVFs; RR, 0.57; P=0.03). Two-stage BBVFs were less likely to lose their functional secondary patency (21.3% vs. 31.6% for one-stage BBVFs; RR, 0.61; P=0.11). This non-significant trend became significant (RR, 0.36; P=0.02) on sensitivity analysis. There was no difference in specific complication rates of the two study groups. Conclusion Among candidates for BBVF fistula, there is evidence to suggest that two-stage BBVFs achieve higher maturation rates compared to one-stage BBVFs. The evidence for difference in long-term secondary patency is less robust, calling for further research.
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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
| | | | | | - Miltos K Lazarides
- Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis, Greece
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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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15
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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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16
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Abstract
As more than 320,000 patients are currently receiving hemodialysis treatment in Japan, the creation and maintenance of hemodialysis access is a major concern. The national guidelines recommend autogenous arteriovenous hemodialysis, and the brachial-basilic arteriovenous fistula has been the focus of attention, because the need for secondary, tertiary, or even more vascular access is growing. Although favorable results have been reported in terms of patency and access-related complication, this fistula involves various unsolved or controversial issues, with limitations including complex procedures, which might contribute to the lower prevalence at this point in Japan. This review addresses those issues and discusses the role of fistula in Japan.
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Affiliation(s)
- Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Osamu Sato
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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17
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Gerrickens MWM, Vaes RHD, Govaert B, Teijink JAW, Scheltinga MR. Basilic vein transposition for unsuitable upper arm hemodialysis needle access segment may attenuate concurrent hand ischemia. Hemodial Int 2018. [DOI: 10.1111/hdi.12654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Roel H. D. Vaes
- Department of Surgery; Máxima Medical Centre; Veldhoven The Netherlands
| | - Bastiaan Govaert
- Department of Surgery; Máxima Medical Centre; Veldhoven The Netherlands
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18
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Kakkos S, Lampropoulos G, Tsolakis I. Regarding "Similar failure and patency rates when comparing one- and two-stage basilic vein transposition". J Vasc Surg 2017; 66:1307. [PMID: 28942857 DOI: 10.1016/j.jvs.2017.05.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Stavros Kakkos
- Department of Vascular Surgery, University Hospital, Patras, Greece
| | | | - Ioannis Tsolakis
- Department of Vascular Surgery, University Hospital, Patras, Greece
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19
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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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20
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Wang S, Wang MS, Jennings WC. Basilic elevation transposition may improve the clinical outcomes for superficialization of basilic arteriovenous fistula veins. J Vasc Surg 2017; 65:1104-1112. [DOI: 10.1016/j.jvs.2016.10.081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/08/2016] [Indexed: 11/16/2022]
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21
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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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22
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Sha HL, Luk TL, Tee SC, Hardin R, Seak CK. Our experience in using the brachial venae comitantes as a native vascular access for hemodialysis. Hemodial Int 2015; 20:293-7. [DOI: 10.1111/hdi.12370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hon Leong Sha
- Division of Vascular Surgery; Sarawak General Hospital; Kuching Sarawak Malaysia
| | - Tien Loong Luk
- Division of Vascular Surgery; Sarawak General Hospital; Kuching Sarawak Malaysia
| | - Sze Chee Tee
- Division of Vascular Surgery; Sarawak General Hospital; Kuching Sarawak Malaysia
| | - Richard Hardin
- Division of Vascular Surgery; Sarawak General Hospital; Kuching Sarawak Malaysia
| | - Chen Ken Seak
- Division of Vascular Surgery; Sarawak General Hospital; Kuching Sarawak Malaysia
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