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

Abstract

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.

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.…”

“…The two-stage approach requires two separate procedures but may allow easier superficialization of an "arterialized vein" and avoids a more invasive procedure if early failure is detected. A number of studies have been published comparing vessel patency and functional patency rates of both approaches, with some suggestion of improved patency with the twostage technique [3][4][5] ; however, there is no clear indication of which approach is best. 6 In the present study, we conducted a systematic review and meta-analysis of studies that compared one-stage vs two-stage BVT to determine which approach results in lower failure rates and improved primary and secondary patency rates.…”

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

“…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.…”

Myofibroblasts: the ideal target to prevent arteriovenous fistula failure?

“…Conversely, a recent retrospective study has shown a better overall functional patency in brachiobasilic AVFs implemented with a two-stage process that includes a complex surgical dissection (stage 1, creation, and stage 2, transposition) than in those created in a single operation. 7 The importance of developing novel periadventitial delivery systems to target early development of NIH in AVF is also recognized by Yang et al 2 The periadventitial delivery of drugs, genes, or cells over the anastomotic region of a newly created fistula can allow higher local treatment concentrations with lower systemic toxicity. 8 This type of delivery has been demonstrated to be less problematic, as the vein and the anastomotic area are accessible for therapies during a surgical procedure.…”