Abstract
IntroductionA brachiobasilic arteriovenous fistula (BB-AVF) can provide access for haemodialysis in patients who are not eligible for a more superficial fistula. However, it is unclear whether one- or two-stage BB-AVF is the best option for patients.AimTo systematically assess the difference between both procedures in terms of access maturation, patency and postoperative complications.MethodsOnline search for randomised controlled trials (RCTs) and observational studies that compared the one-stage versus the two-stage technique for creating a BB-AVF.ResultsEight studies were included (849 patients with 859 fistulas), 366 created using a one-stage technique, while 493 in a two-stage approach. There was no statistically significant difference between the two groups in the rate of successful maturation (Pooled risk ratio = 0.95 [0.82, 1.11], P = 0.53). Similarly, the incidence of postoperative haematoma (Pooled risk ratio = 0.73 [0.34, 1.58], P = 0.43), wound infection (Pooled risk ratio = 0.77 [0.35, 1.68], P = 0.51) and steal syndrome (Pooled risk ratio = 0.65 [0.27, 1.53], P = 0.32) were statistically comparable.ConclusionAlthough more studies seem to favour the two-stage BVT approach, evidence in the literature is not sufficient to draw a final conclusion as the difference between the one-stage and the two-stage approaches for creation of a BB-AVF is not statistically significant in terms of the overall maturation rate and postoperative complications. Patency rates (primary, assisted primary and secondary) were comparable in the majority of studies. Large randomised properly conducted trials with superior methodology and adequate sub-group analysis are needed before making a final recommendation.
Highlights
A brachiobasilic arteriovenous fistula (BB-Arteriovenous Fistula (AVF)) can provide access for haemodialysis in patients who are not eligible for a more superficial fistula
More studies seem to favour the two-stage basilic vein transposition (BVT) approach, evidence in the literature is not sufficient to draw a final conclusion as the difference between the one-stage and PLOS ONE | DOI:10.1371/journal.pone
Brachiobasilic Arteriovenous Fistula: Systematic Review the two-stage approaches for creation of a BB-AVF is not statistically significant in terms of the overall maturation rate and postoperative complications
Summary
The results of the study selection process are summarised in the PRISMA flow diagram [Fig. 1]. Superficial to the deep deep fascia and (oedema, basilic vein basilic vein had diabetes fascia and subcutaneous haematoma, superficialisation elevation and 10/20 had affect outcome subcutaneous tissue tissue rather than thrombosis, techniques procedure hypertensionFor were not rather than through a through a venous the one stage described in subcutaneous tunnel subcutaneous hypertension, basilic vein accordance with tunnel lymph leakage), elevation: Mean the SVS perioperative age = 49.3 Lower patency patency (ability rates for the one to access the stage technique fistula for and increased haemodialysis), chance of mean time to developing use the fistula, postoperative complications complications such as compared to the haematomas two stage requiring technique exploration, wound dehiscence or infection, thrombosis, steal syndrome, venous hypertension requiring intervention, failure to mature. We pooled the data from the 1stage procedures in this last study together in the meta-analysis [35]
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