A comparison between one-stage and two-stage procedures for the creation of brachiobasilic arteriovenous fistulas
| Autor: | Timothy E. Rowlands, Ian L. Sheldrake |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Brachial Artery Fistula medicine.medical_treatment Vascular access Embolectomy Kaplan-Meier Estimate Arteriovenous Shunt Surgical Renal Dialysis medicine Humans Stage (cooking) Vascular Patency Aged Retrospective Studies Aged 80 and over business.industry One stage General Medicine Middle Aged medicine.disease Surgery Cohort Arm Kidney Failure Chronic Case note Female Complication business |
| Zdroj: | International journal of surgery (London, England). 18 |
| ISSN: | 1743-9159 |
| Popis: | Introduction Vascular access is essential to end-stage renal failure patients requiring haemodialysis. Many patients require multiple fistula formation attempts in order to gain good access, making secondary and tertiary fistula options vital. Brachiobasilic fistulas are well established, but there is little evidence to compare the different surgical techniques in creating them. This study aimed to determine the patency and complication rates associated with these procedures. Methods Retrospective data was collected by reviewing case notes to determine fistula survival time and surgical setting. Patency, complications and required interventions were recorded for each group at three time intervals. The Kaplan–Meier method was used to calculate survival for each cohort. Results 37 brachiobasilic arteriovenous fistulas were created in 35 patients. 17 fistulas were one-stage procedures; 20 fistulas were made in two stages. Survival proportions were measured as 70.6%, 58.8% and 51.5% for the one-stage procedure and 95%, 90% and 78% for the two-stage procedure at 1 month, 1 year and 2 years respectively with p = 0.0385. Discussion Native brachiobasilic fistulas have advantages over prosthetic grafts. There are technical aspects which make the two-staged procedure preferable, including being more amenable to a day case surgery setting. Despite this, there is a lack of relative outcome differences in the literature, thus necessitating further work. Conclusion Our data suggests creation of brachiobasilic fistulas using a two-staged procedure may result in improved patency rates. Complication rates were found to be statistically equivocal, with fistuloplasties and embolectomy shown to be effective in fistula salvage. |
| Databáze: | OpenAIRE |
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