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Cheun TJ, Hart JP, Davies MG. Management of depth to achieve timely arteriovenous fistula utilization. J Vasc Surg 2024; 80:545-553.e3. [PMID: 38604320 DOI: 10.1016/j.jvs.2024.03.445] [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] [Received: 01/11/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Failure to achieve timely arteriovenous fistulae (AVFs) utilization due to excessive depth (>6 mm) remains an ongoing concern for dialysis access. This study evaluates the outcomes of radiocephalic (RCF) and brachiocephalic (BCF) fistula elevation required for access utilization. METHODS A retrospective review of all patients undergoing first-time autologous access over 10 years was undertaken. RCF and BCF were analyzed, and cases of initial access failure due to depth alone were selected for study. Primary and staged brachio-basilic AVF were excluded. Outcomes of early thrombosis, line placement, maturation (successful progression to hemodialysis [HD), reintervention, and functional dialysis (continuous HD for 3 consecutive months) were examined. RESULTS From January 2012 to December 2022, 1733 patients (67% female; mean age, 61 ± 14 years) underwent autologous AVF placement. Of these, 298 patients (17%) had depth-related AVF access issues (BCF, 71% and RCF, 29%). Nineteen percent of these AVFs underwent a primary balloon-assisted maturation (BAM), and 2% had side branch coil embolization before consideration for elevation. The average time to intervention for depth was 11 ± 4 weeks after primary creation. During elevation, side branch ligation occurred in 38% of cases, and 15% underwent intraoperative BAM, The pre-elevation depth was 8.2 ± 3.1 mm, and the mean post-elevation depth was 4.7 ± 2.9 mm (P = .002). Early thrombosis (<18 days) occurred in 4% of cases. There was no mortality, and the 30-day major adverse cardiac event rate was 2%, with a 30-day morbidity of 5%, which was driven by wound issues. Six percent of the AVFs underwent follow-up BAM within 3 months. Mean maturation of the AVFs was 74% ± 3% vs 72% ± 3% (P = .58) for the elevation vs no-elevation groups at 24 weeks, respectively. However, there was an increase in tunneled central line placement in pre-emptive fistula patients due to the delay in maturation (elevation, 17% vs no-elevation, 8%; P = .008). There was a mean successful access time of 6 ± 3 weeks after elevation (16 ± 4 weeks after access creation). There was a median of 2.4 secondary interventions per year after elevation compared with a median of 2.7 secondary interventions per year without elevation. Mean access functionality was 68% ± 8% vs 75% ± 8% at 3 years for the elevation vs no-elevation groups, respectively (P = .25). CONCLUSIONS Elevation of deep BCF and RCF occurs late after placement but can be successfully achieved with low morbidity and satisfactory long-term functionality. It results in an increase in tunneled central line placement in pre-emptive fistula patients. Elevation is a valuable adjunct to AVF maturation and enhances an autologous access policy.
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Affiliation(s)
- Tracy J Cheun
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX; Department of Vascular Surgery, Long School of Medicine, San Antonio, TX
| | - Joseph P Hart
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX; Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Mark G Davies
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX; Department of Vascular/Endovascular Surgery, Ascension Health, Waco, TX.
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Masood B, Batool Zaidi SA, Alam S, Mir S. Single stage versus two stage basilic vein transposition for hemodialysis access: A retrospective observational study. J Vasc Access 2023:11297298231210952. [PMID: 37997037 DOI: 10.1177/11297298231210952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The basilic vein transposition is a brachio basilic arteriovenous fistula (AVF) made after the mobilization and transferring of basilic vein to the ventral aspect of arm inside a subcutaneous pocket by direct dissection. The procedure can be performed either in single stage or two stages. This study compares the clinical efficacy and long term utility of single-stage and two-stage basilic vein transposition among patients of renal failure and to evaluate failure rate, primary patency rates, and postoperative complications. METHOD Patients who underwent basilic vein transposition at Sindh Institute of Urology and Transplantation, Karachi from January 2021 to December 2021 were retrospectively reviewed. Patients were divided into two groups according to single stage or two-stage procedure. After the surgical procedure, assessment of fistula maturation and surveillance were undertaken using ultrasound and physical examination. Patients were requested to visit the out-patient clinic for assessment of fistula patency and post-operative complications at regular intervals of 3, 6, and 12 months respectively. RESULT During the 12 months' interval, 82 (39.04%) basilic vein transpositions were performed in single-stage and 128 (60.95%) were two-staged transposition. In our analysis we have found that as compared to single stage, two-stage basilic vein transpositions showed significantly better primary patency rates (76.82% vs 96%; p-value 0.000) and required less interventions for maintaining fistula patency. More post-operative sequelae were noted in the single stage version of the procedure as compared to the two stage procedure. CONCLUSION Two stage procedure of basilic vein transposition is found to have better patency rate and lesser post-surgical complications. However, a matched cohort prospective study is still needed to further strengthen the conclusion.
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Affiliation(s)
- Bilal Masood
- Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | | | - Shabina Alam
- Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Shuahullah Mir
- Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
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Patel RJ, Willie-Permor D, Zarrintan S, Elsayed N, Al-Nouri O, Malas MB. Two-Stage Offers No Advantages over Single-Stage Arteriovenous Creation: An Analysis of Multicenter National Data. Ann Vasc Surg 2023; 96:308-315. [PMID: 37004922 PMCID: PMC10527688 DOI: 10.1016/j.avsg.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/15/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Traditionally, arteriovenous fistulas (AVF) involving the basilic vein (BV) have been created in 1 or 2 stages to allow time for the vein to enlarge before superficialization for potential better fistula maturation. Previous single institution studies and meta-analyses have found conflicting outcomes between single-stage and 2-stage procedures. Our study aims to use a large national database to assess the difference in outcomes between single-stage and 2-stage procedures for dialysis access. METHODS We studied all patients undergoing BV AVF creation in the Vascular Quality Initiative (VQI) from 2011 to 2021. Patients were split into single-stage or a planned 2-stage procedure for dialysis access. Primary outcomes included dialysis use with index fistula, maturity rate, and number of days from surgery to fistula use. Secondary outcomes included patency (defined by physical exam or imaging on follow-up), 30-day mortality, and postoperative complications (bleeding, steal syndrome, thrombosis, or neuropathy). Logistic regression models were used to assess the association between staged dialysis access procedures and primary outcomes of interest. RESULTS The cohort consisted of 22,910 individuals of which 7,077 (30.9%) had a 2-staged dialysis access procedure and 15,833 (69.1%) had a single-staged procedure. Average follow-up was 345 days in the single stage and 420 days for 2-stage. Baseline characteristics were significantly different between the 2 groups in terms of medical comorbidities. Primary outcomes were significant for more patients in the 2-stage group undergoing dialysis with the index fistula compared to single stage (31.5% vs. 22.2%, P < 0.0001), significant decrease in days to use in current dialysis patients (103.9 days single stage versus 141.0 days 2-stage, P < 0.0001), and no difference in maturity at follow-up (19.3% single-stage and 17.4% 2-stage, P = 0.354). Secondary outcomes revealed no difference in 30-day mortality or patency (89.8% single-stage and 89.1% 2-stage, P = 0.383), but a significant difference in postoperative complications with a 2-stage procedure compared to 1-stage (1.6% vs. 1.1%, P = 0.026). Finally, a spline model was used to determine that a preoperative vein of 3 mm or less could be a cutoff in which a 2-stage procedure might be beneficial. CONCLUSIONS This study demonstrates that when dialysis access fistulas are created using the BV, there is no difference in maturity rate or 1-year patency when assessing single-stage versus 2-stage procedures. However, 2-stage procedures significantly delay the time of first use of the fistula and increase postoperative complications. Therefore, we suggest performing single stage procedures when the vein is of appropriate diameter to minimize multiple procedures, complications and expedite time to maturity.
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Affiliation(s)
- Rohini J Patel
- Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), University of California San Diego, San Diego, CA
| | - Daniel Willie-Permor
- Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), University of California San Diego, San Diego, CA
| | - Sina Zarrintan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), University of California San Diego, San Diego, CA
| | - Nadin Elsayed
- Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), University of California San Diego, San Diego, CA
| | - Omar Al-Nouri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), University of California San Diego, San Diego, CA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), University of California San Diego, San Diego, CA.
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Hostalrich A, Boisroux T, Segal J, Lebas B, Ricco JB, Chaufour X. Assessment of Duplex ultrasound carried out by the vascular surgeon after locoregional anesthesia for preferred arteriovenous fistula access. Ann Vasc Surg 2021; 83:117-123. [PMID: 34942337 DOI: 10.1016/j.avsg.2021.11.014] [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: 10/11/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Preoperative vascular mapping by duplex ultrasound is required in construction of an arteriovenous fistula for hemodialysis (AVF). Due to venous vasospasm in cool temperatures and variability of the dialysis patient's blood volume, the conditions for performing this examination may be less than ideal. However, local regional anesthesia (LRA) resulting in vasodilation of the limb, can allow the use of veins considered to be of insufficient caliber during preoperative ultrasound mapping. The aim of this study was to assess the functionality of AVF when duplex ultrasound is performed by the surgeon following LRA. These results were compared with those from the preceding year, during which preoperative duplex ultrasound had been performed without LRA by vascular specialists, (Clinical Trial registration number: NCT04978155). MATERIALS AND METHODS This is a prospective study of all the patients having received AVF after systematic immediate preoperative ultrasound (US) under LRA (US-LRA group) in 2020. The initial surgical programming based on the Silva criteria was reported by a vascular medicine specialist. The change of AVF strategy following US-LRA was reported together with AVF usability and patency and compared to the results of the control group, in which AVF had been performed in 2019 without US-LRA. RESULTS Ninety patients were included in the US-LRA group and 93 in the control group. Modified surgical planning was observed in 38% of cases (35/90) in the US-LRA group including more distal AVF in 28% of patients (26/90) and alternative target vein in 6.6% (6/90). AVF usability at 6 weeks was 80% (72/90) in the US-LRA group and 51.6% (48/93) in the control group (p<.001). Median follow-up was 12 months [IQR:9-15] in the US-LRA group and 13 months [IQR:9-18] in the control group. Primary patency at 6, 12, 18 months was significantly better in the US-LRA group (73.6% vs. 57.4%, 54.4% vs. 40.2%, 31.3% vs. 28.2%, respectively, p<.001). Assisted patency and secondary patency were comparable in the two groups. CONCLUSION This study showed the benefit of having the surgeon perform US-LRA before starting the procedure, thereby allowing for more distal AVF, better usability and patency.
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Affiliation(s)
- Aurélien Hostalrich
- Department of Vascular Surgery, University Hospital Rangueil, Toulouse, France.
| | - Thibaut Boisroux
- Department of Vascular Surgery, University Hospital Rangueil, Toulouse, France
| | - Jean Segal
- Department of Vascular Surgery, University Hospital Rangueil, Toulouse, France
| | - Benoit Lebas
- Department of Vascular Surgery, University Hospital Rangueil, Toulouse, France
| | | | - Xavier Chaufour
- Department of Vascular Surgery, University Hospital Rangueil, Toulouse, France
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Huber TS, Berceli SA, Scali ST, Neal D, Anderson EM, Allon M, Cheung AK, Dember LM, Himmelfarb J, Roy-Chaudhury P, Vazquez MA, Alpers CE, Robbin ML, Imrey PB, Beck GJ, Farber AM, Kaufman JS, Kraiss LW, Vongpatanasin W, Kusek JW, Feldman HI. Arteriovenous Fistula Maturation, Functional Patency, and Intervention Rates. JAMA Surg 2021; 156:1111-1118. [PMID: 34550312 DOI: 10.1001/jamasurg.2021.4527] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance National initiatives have emphasized the use of autogenous arteriovenous fistulas (AVFs) for hemodialysis, but their purported benefits have been questioned. Objective To examine AVF usability, longer-term functional patency, and remedial procedures to facilitate maturation, manage complications, or maintain patency in the Hemodialysis Fistula Maturation (HFM) Study. Design, Setting, and Participants The HFM Study was a multicenter (n = 7) prospective National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases cohort study performed to identify factors associated with AVF maturation. A total of 602 participants were enrolled (dialysis, kidney failure: 380; predialysis, chronic kidney disease [CKD]: 222) with AVF maturation ascertained for 535 (kidney failure, 353; CKD, 182) participants. Interventions All clinical decisions regarding AVF management were deferred to the individual centers, but remedial interventions were discouraged within 6 weeks of creation. Main Outcomes and Measures In this case series analysis, the primary outcome was unassisted maturation. Functional patency, freedom from intervention, and participant survival were summarized using Kaplan-Meier analysis. Results Most participants evaluated (n = 535) were men (372 [69.5%]) and had diabetes (311 [58.1%]); mean (SD) age was 54.6 (13.6) years. Almost two-thirds of the AVFs created (342 of 535 [64%]) were in the upper arm. The AVF maturation rates for the kidney failure vs CKD participants were 29% vs 10% at 3 months, 67% vs 38% at 6 months, and 76% vs 58% at 12 months. Several participants with kidney failure (133 [37.7%]) and CKD (63 [34.6%]) underwent interventions to facilitate maturation or manage complications before maturation. The median time from access creation to maturation was 115 days (interquartile range [IQR], 86-171 days) but differed by initial indication (CKD, 170 days; IQR, 113-269 days; kidney failure, 105 days; IQR, 81-137 days). The functional patency for the AVFs that matured at 1 year was 87% (95% CI, 83.2%-90.2%) and at 2 years, 75% (95% CI, 69.7%-79.7%), and there was no significant difference for those receiving interventions before maturation. Almost half (188 [47.5%]) of the AVFs that matured had further intervention to maintain patency or treat complications. Conclusions and Relevance The findings of this study suggest that AVF remains an accepted hemodialysis access option, although both its maturation and continued use require a moderate number of interventions to maintain patency and treat the associated complications.
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Affiliation(s)
- Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Dan Neal
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Erik M Anderson
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida College of Medicine, Gainesville
| | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham
| | - Alfred K Cheung
- Nephrology and Hypertension Division, University of Utah School of Medicine, Salt Lake City
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | | | - Miguel A Vazquez
- Division of Nephrology, University of Texas Southwestern, Dallas
| | | | | | - Peter B Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alik M Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Massachusetts
| | - James S Kaufman
- Renal Section, Veterans Affairs New York Harbor Healthcare System, New York
| | - Larry W Kraiss
- Division of Vascular Surgery, University of Utah, Salt Lake City
| | | | - John W Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Harold I Feldman
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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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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Haddad DJ, Jasty VS, Mohan B, Hsu CH, Chong CC, Zhou W, Tan TW. Comparing Outcomes of Upper Extremity Brachiobasilic Arteriovenous Fistulas and Arteriovenous Grafts: A Systematic Review and Meta-Analysis. J Vasc Access 2020; 23:32-41. [PMID: 33198574 DOI: 10.1177/1129729820970789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs). METHODS A systematic review was performed to identify all English publications and abstracts comparing the patency outcomes of upper extremity BBAVFs and AVGs (January 1st, 1994 to April 1st, 2020). The outcomes assessed were 1-year and 2-year primary and secondary patency rates. Pooled odds ratios (OR) were calculated using the random-effects model, and I2 statistic was used to assess between-study variability. RESULTS Twenty-three studies examining 2799 patients were identified and included in the study. The 1-year primary patency rates (OR = 1.68, 95% CI 1.24-2.28, p = 0.001, I2 = 69.40%) and 2-year primary patency rates (OR = 2.33, 95% CI 1.59-3.43, p < 0.001, I2 = 68.26%) were significantly better for BBAVFs than AVGs. Compared to AVGs, the 1-year secondary patency rates (OR = 1.45, 95% CI 1.05-1.98, p = 0.022, I2 = 56.64%) and 2-year secondary patency rates (OR = 1.93, 95% CI 1.39-2.68, p < 0.001, I2 = 57.61%) were also significantly higher for BBAVFs. CONCLUSION The outcomes for upper extremity BBAVFs appear to be consistently superior to prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper extremity basilic vein.
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Affiliation(s)
- David J Haddad
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Babu Mohan
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Chiu-Hsieh Hsu
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Wei Zhou
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tze-Woei Tan
- University of Arizona College of Medicine, Tucson, AZ, USA
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Kim MS, Min SK, Ahn S, Kim HG, Choi C, Mo H, Han A, Ha J. Modified Brachio-basilic/brachial Arteriovenous Fistula Creation with Short-segment Elevation Preserving the Axilla. Ann Vasc Surg 2020; 67:448.e1-448.e10. [DOI: 10.1016/j.avsg.2020.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
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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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Baliga K. Single-Staged arm basilic vein transposition for arteriovenous fistula surgery - clinical pearls and outcomes. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Comparison of forearm versus upper arm basilic transposition arteriovenous fistulas demonstrates equivalent satisfactory patency. J Vasc Surg 2019; 70:1247-1252. [DOI: 10.1016/j.jvs.2019.01.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022]
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12
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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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13
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Wee IJY, Mohamed IH, Patel A, Choong AMTL. Reply. J Vasc Surg 2019; 70:660-661. [PMID: 31345481 DOI: 10.1016/j.jvs.2018.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 10/26/2022]
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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14
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Antoniou GA, Georgiadis GS. Regarding "A systematic review and meta-analysis of one-stage versus two-stage brachiobasilic arteriovenous fistula creation". J Vasc Surg 2019; 70:659-660. [PMID: 31345480 DOI: 10.1016/j.jvs.2018.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - George S Georgiadis
- Department of Vascular and Endovascular Surgery, University Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece
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15
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Mestres G, Gonzalo B, Mateos E, Yugueros X, Martínez-Rico C, Marcos L, Blanco C. Comparison of side-to-end vs. side-to-side proximal arteriovenous fistula anastomosis in chronic renal failure patients. Vascular 2019; 27:628-635. [PMID: 31060450 DOI: 10.1177/1708538119847392] [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: 11/16/2022]
Abstract
Introduction Anastomotic creation of autogenous arteriovenous fistulas can be performed in different ways, side-to-end or side-to-side. However, there is a paucity of evidence to recommend them. The aim of this study is to compare both anastomosis types in elbow arteriovenous fistulas. Material and methods A prospective observational national multicenter study (ISRCTN62033470) was designed, including patients receiving a native arteriovenous fistula in the elbow using side-to-end or side-to-side anastomosis, between September, 2016 and September, 2017, with six-month postoperative follow-up period. Patient characteristics, surgical details, and follow-up data (primary, assisted primary and secondary patency, maturation, functionality, complications) were recorded and compared between both anastomosis groups using Kaplan–Meier curves estimations, at one and six-month follow-up, and finally a multivariate analysis with Cox regression was performed. Results Three centers participated in the study, including 133 cases (96 side-to-end, 37 side-to-side). The cephalic vein was more often used for side-to-end (58.3%) and basilic for side-to-side (78.4%; P < 0.001). Side-to-end anastomoses were faster to create (65.1–75.1 min; P = 0.009). During follow-up, 23 cases were lost (transplanted, dead, ligated, or lost), with no differences at one month. At six months, primary patency was better for the side-to-end group (78.5 − 55.9%; P = 0.038), but it was not confirmed as an independent predictor in the multivariate analysis. Furthermore, no significant differences in assisted primary or secondary patency, maturation or functionality were seen. Patients with side-to-side anastomosis more often required vein superficialization (2.1–16.2%; P = 0.002) and presented more frequent puncture hematomas (4.9–30.0%; P = 0.015). Conclusions Anastomosis type was not significantly related to different outcomes in the follow-up. Even though side-to-end anastomosis showed better primary patency at six months with lower need of vein superficialization and fewer puncture hematomas during follow-up, it was not confirmed as an independent predictor in the multivariate analysis, and similar assisted primary and secondary patency, maturation, and functionality rates have been seen after arteriovenous fistula creation.
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Affiliation(s)
- Gaspar Mestres
- Vascular Access Unit, Vascular Surgery Division, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Begoña Gonzalo
- Vascular Surgery Department, Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Eduardo Mateos
- Vascular Surgery Department, Parc de Salut - Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Yugueros
- Vascular Access Unit, Vascular Surgery Division, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carlos Martínez-Rico
- Vascular Surgery Department, Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Lidia Marcos
- Vascular Surgery Department, Parc de Salut - Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | - Carla Blanco
- Vascular Access Unit, Vascular Surgery Division, Hospital Clinic, University of Barcelona, Barcelona, Spain
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16
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Comparison of one-stage and two-stage upper arm brachiobasilic arteriovenous fistula in the Vascular Quality Initiative. J Vasc Surg 2019; 69:1187-1195.e2. [DOI: 10.1016/j.jvs.2018.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022]
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17
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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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18
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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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