Gunilla Welander, Fredrik Lundin, Hawshin Palanjafi, Birgitta Sigvant
{"title":"Outcomes of Single or Two Stage Brachiobasilic Arteriovenous Fistula: A Nationwide Swedish Registry Study.","authors":"Gunilla Welander, Fredrik Lundin, Hawshin Palanjafi, Birgitta Sigvant","doi":"10.1016/j.ejvs.2024.12.027","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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<sup>2</sup> 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejvs.2024.12.027","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
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/m2 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.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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