Two-stage Brachiobasilic Arteriovenous Fistula Research Articles

Comparison of wound complications between one-stage and two-stage brachiobasilic arteriovenous fistula: A meta-analysis.

Research assessing the outcome of brachiobasilic arteriovenous fistulas (BB-AVF) after a one- and two-stage technique was conducted. A strict review of the comprehensive literature up to May 2023 was carried out using four databases-PubMed，Embase, Cochrane Library and web of science. Inclusion and exclusion criteria developed for the study were then applied to assess the quality of the literature, it was decided to review 12 interrelated studies.95% confidence intervals (Cl) and odds ratios (OR) were calculated using fixed effects models. The data were meta-analysed using RevMan 5.3 software. The results showed that two-stage technique with BB-AVF reduced surgical site haematoma (SSH) formation, (OR, 2.28; 95% CI, 1.24-4.17, p = 0.008), and also reduced surgical site wound infection (SSWI) (OR, 1.86; 95% CI, 1.17-2.94, p = 0.008). There are, however, several small sample sizes in the selected studies for this meta-analysis, so caution should be used when processing their values. There are more high-quality studies with large sample sizes that should be considered for future meta-analyses.

A Comparison Between One- and Two-Stage Brachiobasilic Arteriovenous Fistulas in Terms of Functional Patency

A Comparison Between One- and Two-Stage Brachiobasilic Arteriovenous Fistulas in Terms of Functional Patency

Outcomes of Local and Regional Anesthesia for Superficialization of Brachiobasilic Arteriovenous Fistulas

Superficialization, the second stage of a two-stage brachiobasilic arteriovenous fistula (BB-AVF), can be performed under local (LA), regional (RA), or general anesthesia (GA). Given the numerous comorbidities in patients with end-stage renal disease (ESRD), our preference is to use RA or LA when feasible. Our goal was to review the success rate of RA and LA, need for conversion to GA, and cardiac morbidity and mortality for BB-AVF superficialization. We performed a retrospective cohort analysis of patients who underwent BB-AVF creation with second-stage superficialization over a 4-year period. The primary outcome measures included need for conversion to GA, myocardial infarction (MI), and 30-day mortality. A secondary outcome was total operative time (time from preoperative briefing to the time the patient left the operating room). We analyzed the data using Fisher Exact test for categorical data and nonparametric analysis for continuous data. There were 42 patients who underwent BB-AVF superficialization. The median age was 56years, with a mean body mass index of 29. Most patients were male (55%) and predominantly Hispanic/Latino (60%). RA was utilized in 35 patients (83%), LA in 5 (12%), and GA in 2 (5%). The conversion rate from RA to GA was 0% and was 20% (n=1) from LA to GA. There were no postoperative MI or deaths. There was no significant difference in total operative time (219.6min for RA, 234.5min for LA, and 278min for GA, (P=0.37)). Local and/or regional anesthesia can be successfully used in the majority of patients undergoing BB-AVF superficialization. LA and RA are associated with negligible cardiac morbidity and mortality. Conversion from RA to GA is rare. Use of RA does not result in a longer total operative time.

Comparison of one-stage and two-stage upper arm brachiobasilic arteriovenous fistula in the Vascular Quality Initiative

ObjectiveAn upper arm brachiobasilic arteriovenous fistula (BBAVF) is a reliable autogenous hemodialysis access created with a one-stage or two-stage technique. Although both techniques are variably used, the optimal approach is uncertain. In this study, we compared the outcomes of one-stage and two-stage BBAVF procedures. MethodsWe identified 2648 patients who had received BBAVFs within the Vascular Quality Initiative data set (2010-2016) and compared those created using the one-stage and two-stage technique. The primary outcome measures were primary and secondary patency rates at 12 months. Other outcomes assessed were wound infection, steal, and swelling at 3 months. The log-rank test was used to evaluate patency by Kaplan-Meier analysis. Cox proportional hazards models were used to examine the adjusted association between surgical technique and outcomes. ResultsThere were 1234 (47%) one-stage and 1414 (53%) two-stage BBAVFs in the study cohort, including 1848 (70%) patients who were on dialysis at the time of surgery and 1795 (68%) patients with a history of previous access. Patients who underwent a one-stage BBAVF were more likely to be male (54% vs 45%; P < .001), to be white (60% vs 41%; P < .001), and to have a history of coronary artery disease (22% vs 17%; P = .001). Patients undergoing one-stage BBAVFs have larger vein diameters (4.1 vs 3.4 mm; P < .001) and have the procedure in an inpatient setting (21% vs 13%; P < .001) compared with patients undergoing a two-stage procedure. The 12-month primary patency rate was higher for the one-stage BBAVF (49.1% vs 40.4%; P = .005), although the secondary patency rate was comparable (80.0% vs 77.9%; P = .54). Postoperative bleeding (4% vs 1.5%; P < .001), wound infection (1.01% vs 0.4%; P = .047), and arm swelling (2.1 % vs 0.8%; P = .006) were higher for one-stage BBAVFs. In multivariable analysis, although loss of primary patency at 12 months (adjusted hazard ratio [aHR], 1.12; 95% confidence interval [CI], 0.97-1.30; P = .12) and 3-month wound infection (aHR, 0.42; 95% CI, 0.14-1.25, P = .12) were similar between the two approaches, the risk of 3-month arm swelling was significantly lower for two-stage BBAVFs (aHR, 0.35; 95% CI, 0.16-0.77; P = .009). ConclusionsWhereas surgeons were more likely to perform a two-stage BBAVF in patients with a history of previously failed access and smaller basilic vein, our data show no difference in primary or secondary patency of one-stage and two-stage BBAVFs at 12 months.

Basilic Vein Superficialization Is an Effective Alternative to Transposition in Patients Requiring Brachiobasilic Arteriovenous Fistula

The goal of this study was to compare outcomes for techniques in the creation of brachiobasilic arteriovenous fistulas, namely in the second stage basilic vein transposition or the second stage basilic vein superficialization. We performed a retrospective review of patients undergoing two-stage brachiobasilic arteriovenous fistula construction at an urban academic medical center between 2012 and 2017. The second stage consisted of either tunneling the basilic vein and reanastomosis to the brachial artery, that is, “transposition,” or “superficialization,” which mobilized the basilic vein into the anterolateral subcutaneous plane through creation of a flap. Operative time, postoperative morbidity, access maturation, primary patency, and need for subsequent interventions were compared. In all 58 patients (29 male; mean age, 58 years) underwent a two-stage brachiobasilic arteriovenous fistula construction, 19 of which had a second stage superficialization (Table). The mean follow-up was 30 months. The second stage required significantly less time for superficialization compared with transposition (113 minutes vs 188 minutes, respectively; P < .001). The mean estimated blood loss was lower for superficialization at 45 mL compared with transposition at 84 mL (P = .18). The postoperative incidence of thrombosis, hematoma, and wound infection with superficialization (10.5%, 5.3%, and 10.5%, respectively) was lower than with transposition (17.9% [P = .46], 12.8% [P = .38], and 15.4% [P = .62], respectively); however, this difference failed to reach statistical significance. Access maturity was achieved in 94.7% of superficialization patients compared with 84.6% of transpositions (P = .27). Primary patency for superficialization was 89%, 79%, 63%, and 57.9% at 3, 6, 12, and 18 months, respectively, whereas for transposition it was 74%, 62%, 49%, and 41% at 3, 6, 12, and 18 months, respectively. The incidence of high-grade stenosis requiring intervention was significantly lower with superficialization than transposition (10.5% vs 58.9%; P < .001), leading to fewer percutaneous interventions after fistula creation. The reanastomosis site in transpositions was the location of 74% of high-grade stenoses requiring intervention, whereas none of the superficializations had problems with the AV anastomosis. Second-stage superficialization of the brachiobasilic arteriovenous fistula is an effective alternative to transposition given its shorter operative time, improved primary patency, and a lower need for percutaneous interventions after construction.TableResultsSuperficialization (n = 19)Transposition (n = 39)P valueGender11 M, 8 F18 M, 21 FAge, years6056.16Used left arm16/19 (84%)32/39 (82%)Interval between creation and second stages, days7883.79Operative time, minutes Creation109111.88 Second stage113188<.001Estimated blood loss at second stage, mL4584.18Complications High-grade stenosis10.5%59.0%<.001 Aneurysm formation21.1%25.6%.71 Thrombosis10.5%17.9%.47 Postoperative hematoma5.3%12.8%.38 Postoperative wound infection10.5%15.4%.62Primary patency 3 months89.5%74.4% 6 months78.9%61.5% 12 months63.2%48.7% 18 months57.9%41.0% Open table in a new tab

PC094. Two-Stage Brachiobasilic Arteriovenous Fistula Creation Is Cost Effective

There are two established strategies for creating brachiobasilic arteriovenous fistula (BB-AVF), a one-stage and two-stage approach. Although the comparative effectiveness of one-stage versus two-stage BB-AVF have been studied by multiple single center studies, a small randomized controlled trial and two meta-analyses, neither strategy has been shown to be superior with regards to durability, patency, or complications. This study was designed to evaluate the relative cost effectiveness of these different BB-AVF strategies. A Markov decision analytic model was developed to estimate the costs, effects in quality-adjusted life-years (QALYs), and cost effectiveness of a one-stage and two-stage BB-AVF creation strategy. The model begins at the time of surgery for a new AVF and models a 5-year timespan using 1-month cycle lengths from the payer perspective. The baseline values, ranges, and costs were obtained from a systematic review of the literature and Centers for Medicare and Medicaid Services reimbursement by Current Procedural Terminology code. One-way and probabilistic sensitivity analyses were performed to evaluate parameter uncertainty. A 3% annual discount rate was applied and all costs were converted to 2016 U.S. dollars. In the base case, the two-stage approach was both more expensive ($4730 vs $4412) and more effective (3.74 vs 3.41 QALY) over the 5-year model. At a willingness to pay threshold of $50,000/QALY the two-stage approach was the dominant strategy with an incremental cost-effectiveness ratio of $948.36. A one-way sensitivity analysis identified the probability of the two-stage fistula failing to mature and the primary patency rates of both approaches as the inputs with the most impact on the model. In the probabilistic sensitivity analysis, the two-stage approach was the most cost-effective strategy in 70% of the iterations. Despite the additional resources associated with a two-stage BB-AVF, this strategy is more cost effective than a one-stage approach.

UPPER ARM BASILIC VEIN TRANSPOSITION FOR HEMODIALYSIS: WHAT IS THE OPTIMAL TECHNIQUE?

Objective: The brachiobasilic arteriovenous fistula (BBAVF) can be formed in one or two stages. This study examined the failure rates and functional patencies of one-stage vs two-stage brachiobasilic transposition fistulas to compare the two surgical techniques. Patients and methods: 50 BB fistulae (25 single and 25 two-stage) were created over a 3year period (2012-2015). Data including sex, age, dialysis and diabetic status was collected from the case notes. Patency and time to maturity data was collected prospectively from the dialysis unit. Results: During the study interval, 100 brachiobasilic transpositions (50 one-stage and 50 two-stage) were performed in 100 patients. Patients undergoing the two-stage procedure tended to be older (mean 49 vs 53 years; P = 0.8). The two-stage BBAVFs had significantly better primary (88% vs 92%; P=0.58), and secondary functional (92% vs 96%; P=0.508.) patencies. Pre-HD fistula has better patency than post-HD fistula (100% vs 90%; p=0.015) Conclusion: This study describes a series of BBAVFs and makes comparison between the one-stage and two-stage operations. Significantly improved overall functional patency is demonstrated for the two-stage operation. Keywords: Brachiobasilic, Fistula, Transposition

Higher Patency of Transposed Brachio-Basilic Arteriovenous Fistulas Compared to Brachio-Axillary Grafts for Hemodialysis Patients

We compared outcomes of transposed brachio-basilic arteriovenous fistulas (BBAVF) with brachio-axillary prosthetic grafts (BAPG) for hemodialysis. All consecutive patients who underwent creation of a BBAVF or a BAPG, in one of the two institutions, between January 2008 and December 2013 were retrospectively identified. We assessed functional patency and compared complication rates. Patency was also compared between one-stage and two-stage creation procedures for the BBAVF group. Two hundred and thirty-eight patients underwent the creation of a BBAVF (N = 136) or a BAPG (N = 102). Median follow-up was 17 months (range, 1-79). At 6, 12 and 24 months, patients in the BBAVF group had significantly higher primary patency (80%, 69%, 56% vs. 77%, 56%, 37%, respectively; p = 0.005), assisted primary patency (90%, 80%, 71% vs. 80%, 66%, 48%; p&lt;0.0001) and secondary patency (93%, 84%, 72% vs. 94%, 87%, 62%; p = 0.006). Two-stage BBAVF had a significantly higher secondary patency (98%, 92%, 78% vs. 90%, 80%, 68%; p = 0.04) than one-stage BBAVF. The rate of infectious complications was significantly lower in the BBAVF group than in the BAPG group (0.8% vs. 6.9%; p = 0.03). In this large cohort, BBAVF had a higher functional patency and lower rate of infectious complications than BAPG. After exhaustion of cephalic veins, we suggest creation of a BBAVF instead of BAPG, whenever anatomically feasible. The superiority of one-stage or two-stage BBAVF creation procedure must be further investigated.

One-stage vs. two-stage brachio-basilic arteriovenous fistula for dialysis access: a systematic review and a meta-analysis.

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.

A comparison of the outcomes of one-stage and two-stage brachiobasilic arteriovenous fistulas

The brachiobasilic arteriovenous fistula (BBAVF) can be formed in one or two stages. This study examined the failure rates and functional patencies of one-stage vs two-stage brachiobasilic transposition fistulas to compare the two surgical techniques. We retrospectively identified all the patients who underwent BBAVF access surgery at King's College Hospital between January 1, 2009, and December 31, 2011 (3 years). Patients were divided into two groups according to one-stage or two-stage procedure. All patients were seen in the access clinic 4 to 6 weeks postoperatively, and their fistulas were scanned (duplex). The surveillance of fistulas consists of duplex scans every 6 months to assess volume flow. During the study interval, 149 brachiobasilic transpositions (65 one-stage and 84 two-stage) were performed in 141 patients. Patients undergoing the two-stage procedure had a smaller mean preoperative vein diameter (4.0 ± 1.1 vs 3.6 ± 1.3 mm; P = .041) and tended to be older (58 ± 15 vs 63 ± 15 years; P = .062). Mean overall follow-up was 559 ± 333 days. There was no difference in primary failure between the two groups (45% vs 42%; P = .718). At 1 year, the two-stage BBAVFs had significantly better primary (71% vs 87%; P = .034), assisted primary (77% vs 95%; P = .017), and secondary functional (79% vs 95%; P = .026) patencies. The same applied to 2-year primary (53% vs 75%; P = .034), assisted primary (57% vs 77%; P = .017), and secondary functional (57% vs 77%; P = .026) patencies. Multivariate Cox regression showed that the one-stage procedure was 3.2 times more likely to fail (P = .028). Men were 2.7 times more likely to lose their access (P = .054). This study describes a large series of BBAVFs and makes an extensive comparison between the one-stage and two-stage operations. Significantly improved overall functional patency is demonstrated for the two-stage operation.

A comparison between one- and two-stage brachiobasilic arteriovenous fistulas

A comparison between one- and two-stage brachiobasilic arteriovenous fistulas

A comparison between one- and two-stage brachiobasilic arteriovenous fistulas

A comparison between one- and two-stage brachiobasilic arteriovenous fistulas

A comparison between one- and two-stage brachiobasilic arteriovenous fistulas

Brachiobasilic arteriovenous fistulas (BBAVF) can be performed in one or two stages. We compared primary failure rates, as well as primary and secondary patency rates of one- and two-stage BBAVF at two institutions. Patients undergoing one- and two-stage BBAVF at two institutions were compared retrospectively with respect to age, sex, body mass index, use of preoperative venous duplex ultrasound, diabetes, hypertension, and cause of end-stage renal disease. Categorical variables were compared using chi-square and Fisher's exact test, whereas the Wilcoxon rank-sum test was used to compare continuous variables. Patency rates were assessed using the Kaplan-Meier survival analysis and the Cox proportional hazards model with propensity analysis to determine hazard ratios. Ninety patients (60 one-stage and 30 two-stage) were identified. Mean follow-up was 14.2 months and the mean time interval between the first and second stage was 11.2 weeks. Although no significant difference in early failure existed (one-stage, 22.9% vs two-stage, 9.1%; P = .20), the two-stage BBAVF showed significantly improved primary functional patency at 1 year at 88% vs 61% (P = .047) (hazard ratio, 0.2 (95% confidence interval [CI], .04-.80; P = .03). Patency for one-stage BBAVF markedly decreased to 34% at 2 years compared with 88% for the two-stage procedure (P = .047). Median primary functional patency for one-stage BBAVF was 31 weeks (interquartile range [IQR], 11-54) vs 79 weeks (IQR, 29-131 weeks) for the two-stage procedure, respectively (P = .0015). Two-year secondary functional patency for one- and two-stage procedures were 41% and 94%, respectively (P = .015). Primary and secondary patency at 1 and 2 years as well as functional patency is improved with the two-stage BBAVF when compared with the one-stage procedure. Lower primary failure rates prior to dialysis with the two-stage procedure approached, but did not reach statistical significance. While reasons for these finding are unclear, certain technical aspects of the procedure may play a role.

A Comparison Between Single- and Two-Stage Brachiobasilic Arteriovenous Fistulas

Objectives: Controversy exists as to whether the brachiobasilic arteriovenous fistula (BBAVF) should be performed in one or two stages. We compare primary failure rates, as well as primary and secondary patency rates, of one- and two-stage BBAVF. Methods: Patients undergoing one- and two-stage BBAVF at two institutions were compared retrospectively with respect to age, sex, body mass index, use of preoperative venous duplex ultrasound, diabetes, hypertension, and causes of end-stage renal disease. Categoric variables were compared using χ2 and Fisher exact test. The Wilcoxon rank sum test was used to compare continuous variables. Primary and secondary patency rates were assessed using Kaplan-Meier survival analysis and the Cox proportional hazards model. Results: The study identified 90 patients (60 one-stage and 30 two-stage). Mean follow-up was 14.2 months, and the mean time interval between the first and second stage was 11.2 weeks. Three patients in each group required procedures to maintain assisted primary patency. Although no significant difference in early failure existed (one-stage, 22.9% vs two-stage, 9.1%, P = .2), the two-stage BBAVF showed significantly improved primary patency (hazard ratio, 0.31; 95% CI, 0.09-0.99; P = .048) and significantly improved secondary patency (hazard ratio, 0.18; 95% CI, 0.04-0.84; P = .03). Mean primary patency for one stage BBAVF was 72.3 weeks and two-stage was 138 weeks (1 SD; P = .05). Mean secondary patency was 94 weeks and 139 weeks, respectively (1 SD; P = .05). Primary patency at 1 year for one- and two-stage stage BBAVF was 78% and 84%, respectively (P = .05). Functional primary patency at 1 year for one- and two-stage BBAVF was 61% and 88%, respectively (P = .05). Complication rates were not statistically different (each greater than P = .11). Conclusions: Patency rates appear to be improved with the two-stage BBAVF. There is no difference in the complication rate. Optimal surgical techniques for patients undergoing BBAVF for dialysis are discussed. Longer-lasting hemodialysis access improves patient outcome and decreases morbidity associated with dialysis.