Comparison of patient-specific factors and outcomes for one- and two-stage basilic vein transposition fistulas

Shevitz, Andrew J.; Kim, Ann H.; Morrow, Katherine L.; Johnson, D. J.; Campos, Patricia R.; Kashyap, Vikram S.; Wong, Virginia L.

doi:10.1016/j.jvs.2018.02.026

Cited by 4 publications

(9 citation statements)

References 18 publications

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“…Current evidence is not decisive on whether one-stage or two-stage BBT-AVF technique is superior. 11 Current practice relies mostly on surgeon preference. 5,[12][13][14] In the F I G U R E 1 Transposition and arteriovenous reanastomosis of the basilic vein in the second-stage operation of two-stage approach two-stage technique, there is a need for a subsequent surgical intervention and therefore a few weeks of delay in dialysis via this vascular access.…”

Section: Discussionmentioning

confidence: 99%

Transposition of brachiobasilic arteriovenous fistulas: One‐stage or two‐stage technique and factors affecting the early maturation

Özhan¹,

Memetoğlu²,

Kehlіbar³

et al. 2021

Ther Apher Dial

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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 followup 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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Section: Discussionmentioning

confidence: 99%

Transposition of brachiobasilic arteriovenous fistulas: One‐stage or two‐stage technique and factors affecting the early maturation

Özhan¹,

Memetoğlu²,

Kehlіbar³

et al. 2021

Ther Apher Dial

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“…In two retrospective studies (Kakkos and Agarwal), maturation rates were higher in patients undergoing a single-stage BBTx, while another two studies (Hossney and Shevitz) found similar maturation rates in both groups. 3,18,19,37–39 Only Gaffarian found better results in the staged group, although the maturation rate in the single-stage group was only 67%.…”

Section: Discussionmentioning

confidence: 95%

One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art

et al. 2019

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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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“…The transposition of the BV subcutaneously may Figure 3. Basilic vein (arrows) with ligated collaterals, dilated with 0.9% saline solution and exposed brachial artery (arrowheads) in the ulnar fossa be performed during AVF creation (one-stage procedure) or may follow the AVF maturation (twostage procedure, when the first stage is a brachiobasilic arteriovenous anastomosis) [11][12][13][14]. The definitive answer to the question of whether one-stage or two-stage technique is optimal is still uncertain and needs a large randomized prospective study.…”

Section: One-stage Basilic Vein Tunneled Transposition For Hemodialysmentioning

confidence: 99%

“…Authors emphasize that maturation, patency, failure and complication rates may suggest equivalence of both techniques. However, it is also emphasized that the strength of the evidence is limited [13,[15][16][17]. Some authors report that the one-stage technique decreases the time of maturation and the time to the first cannulation.…”

Section: One-stage Basilic Vein Tunneled Transposition For Hemodialysmentioning

confidence: 99%

“…Some authors report that the one-stage technique decreases the time of maturation and the time to the first cannulation. This technique also minimizes the risk of catheter-related infections, since it shortens the time of catheter-based HD [13]. The two-stage procedure is recommended if the basilic vein is less than 4 mm in size [15].…”

Section: One-stage Basilic Vein Tunneled Transposition For Hemodialysmentioning

confidence: 99%

See 1 more Smart Citation

One-stage basilic vein tunneled transposition for hemodialysis access

Sułkowski¹,

Osuch²,

Matyja³

et al. 2021

Arch Med Sci Civil Dis

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Comparison of patient-specific factors and outcomes for one- and two-stage basilic vein transposition fistulas

Cited by 4 publications

References 18 publications

Transposition of brachiobasilic arteriovenous fistulas: One‐stage or two‐stage technique and factors affecting the early maturation

Transposition of brachiobasilic arteriovenous fistulas: One‐stage or two‐stage technique and factors affecting the early maturation

One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art

One-stage basilic vein tunneled transposition for hemodialysis access

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