Outcomes of Single‐Stage Compared to Two‐Stage Basilic Vein Transposition Fistulae

Abstract

Basilic vein transposition (BVT) fistulae are increasing in prevalence in the United States. We examined outcomes of BVT fistulae created in a single stage compared to those created in two stages. Prospective QA databases identified a consecutive cohort of 144 patients with BVT fistulae. Of these, 42% were created in one stage and 58% in two stages. Fistula maturation rates, mean time to fistula use and intensity of percutaneous interventions were compared; patency rates were compared from time of first intervention. Maturation rates (including assisted maturation) were 90% among 1-stage and 75% among 2-stage BVT (p = 0.02). Mean time to initiation of fistula use was 142 days (1-stage) and 146 days (2-stage) (p = 0.92). Intensity of percutaneous interventions was 1.84/patient-year of dialysis (PYD) (1-stage) and 2.15/PYD (2-stage) (p = 0.57). Secondary patency at 1, 2, 3, and 4 years for 1-stage BVT was 86%, 75%, 69%, and 57%; secondary patency at 1, 2, 3, and 4 years for 2-stage BVT was 76%, 71%, 49%, and 25%, respectively (p = 0.12). BVT creation in two stages confers only a modest reduction in maturation rates and secondary patency and therefore should be considered over a synthetic graft in patients with basilic veins deemed inadequate for 1-stage BVT.

Similar failure and patency rates when comparing one- and two-stage basilic vein transposition

“…15 The eight remaining studies that reported on 882 patients met the inclusion criteria and consisted of one randomized controlled trial (RCT) 3 and seven retrospective, observational, cohort studies. 4,5,[16][17][18][19][20] Study baseline characteristics are summarized in Table I. Five of the studies were from the United States, with one each from the United Kingdom, Turkey, and Egypt.…”

“…This occurred despite that some of the studies preferentially selected patients with smaller basilic veins to undergo a two-stage as opposed to a one-stage fistula. 5,18,20 The only difference between the groups was a trend toward reduced thrombosis rates (Fig 6) among patients with a two-stage operation, possibly the result of handling an arterialized vein as opposed to a thin-walled, friable, nonmatured basilic vein. 16 It is thought that extensive mobilization and handling of a thin-walled basilic vein predispose it to ischemia, injury, or kinking, which may affect maturation and patency.…”

“…If these patients were universally excluded from the analysis, the failure and patency rates would be biased in favor of the two-stage procedure. In five of the studies, these patients were included in the outcomes, [3][4][5]17,20 whereas it was unclear how two of the studies handled these patients. 18,19 Only one study clearly excluded these patients from the analysis.…”

Brachial‐cephalic fistula recovered with drainage for the basilic vein: Case report

“…This type of access allows the arterialization of the basilic vein of the forearm and arm. It helps to increase the diameter of the basilic vein, facilitating its future transposition in a single stage . In fact, it allows to do the cannulation earlier than if the basilic vein transposition was made in two stages.…”

“…It helps to increase the diameter of the basilic vein, facilitating its future transposition in a single stage. 7,8 In fact, it allows to do the cannulation earlier than if the basilic vein transposition was made in two stages. This type of fistula consents maximizing the usage of cephalic vein, as well as increases the number the accesses that can to be created at the forearm level.…”