Outcomes of Single or Two Stage Brachiobasilic Arteriovenous Fistula: A Nationwide Swedish Registry Study.

Autor: Welander G; Department of Medical Sciences, Uppsala University, Uppsala, and Department of Nephrology, Central Hospital Karlstad, Karlstad, Region Värmland, Sweden. Electronic address: gunilla.welander@medsci.uu.se., Lundin F; Center of Clinical Research, Karlstad, Region Värmland, Sweden., Palanjafi H; Central Hospital Karlstad, Karlstad, Region Värmland, Sweden., Sigvant B; Department of Surgical Sciences, Uppsala University, Uppsala, and Centre of Clinical Research, Karlstad, Region Värmland, Sweden.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 Dec 18. Date of Electronic Publication: 2024 Dec 18.
DOI: 10.1016/j.ejvs.2024.12.027
Abstrakt: Objective: Creation of a basilic vein arteriovenous transposition fistula (BBAVF) can be performed either as a one or two stage procedure; however, evidence for the best technique is conflicting. The aim of this national registry review was to determine whether functional outcomes favoured either method.
Methods: This was an observational retrospective study with data from the Swedish Renal Registry. BBAVFs created in patients aged ≥ 18 years in 2011 - 2019 were included and were categorised as one stage (BB1) or two stage (BB2). Outcome, patency, and complications were captured from creation onwards, as were all open and endovascular repeat procedures.
Results: BB1s (n = 224) were more common than BB2s (n = 83). Of the BB2s, 66 (80%) were transposed in the second stage. The most common reason for not performing transposition was occlusion (n = 10). Median follow up time was 2 years (interquartile range [IQR] 0.8, 4.2). Overall, 31% of BBAVFs were never used. Vein stenosis was common, seen in 157 BB1s (70%) and 40 BB2s (48%). The incidence of endovascular interventions per patient year was two times higher in BB1s than BB2s (0.6 vs. 0.3). Primary patency at one year was 39% and 54% in BB1 and BB2, respectively (p = .002). Secondary patency at one and three years was similar between groups (BB1 81% and 69%, and BB2 82% and 78%; p = .14). Diabetes as a comorbidity and female sex were associated with worse patency, but body mass index ≥ 30 kg/m 2 was not. Creation pre-dialysis did not affect patency. The median time from creation to first puncture was 73 days (IQR 51, 157) and 141 days (IQR 105, 225) for BB1 and BB2, respectively.
Conclusion: The two stage method had superior primary patency, counterbalanced by two operations. Long term patency was equivalent for the two surgical techniques. The incidence of endovascular re-interventions was high, and BBAVFs were less usable in females and patients with diabetes as a comorbidity.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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