Brachiobasilic Fistula Formation – Single versus Two Stage Procedure

Robertson, Bernard F.; Robertson, Greg; Khan, Lucy R.; Raza, Zahid

doi:10.1016/j.ejvs.2013.03.003

Cited by 16 publications

(23 citation statements)

References 16 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Cooper

Power

DeRose

et al. 2015

Journal of Vascular Surgery

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Meta-analysis of the existing literature comparing one-stage and two-stage basilic vein transposition suggests no difference in failure and patency rates, despite the two-stage procedure's being used in patients with smaller basilic veins. These findings are limited by the small size, observational design, and inconsistent quality of included studies. Reserving a two-stage procedure for patients with smaller basilic veins appears justified, although the strength of the evidence is limited.

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Section: Resultsmentioning

confidence: 99%

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

Cooper

Power

DeRose

et al. 2015

Journal of Vascular Surgery

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“…Basilic vein diameter, for instance, was the primary consideration in the study by Ozcan et al,4 in which patients with a diameter larger than 3 mm underwent a one-stage procedure. However, vein diameter was not a consideration in the study by Robertson et al,5 in which decisions were dependent on the patient's preference, urgency of fistula, and availability of operating time. 5 This was similarly observed in the study by Ghaffarian et al 6 Interestingly, in the same study, the mean basilic vein diameter was larger in the two-stage arm in comparison to the one-stage arm.…”

Section: Replymentioning

confidence: 99%

“…We noticed that hazard ratio (HR) which is related to time, could be extracted to overcome this bias and would make the result more convincing. For example, in the meta-analysis of mortality, HR could be directly found in the study of Armstrong et al 5 and Bonaca et al 6 In the study of Strobl et al, 3 HR could be extracted and calculated from the Kaplan-Meier curve using Engauge Digitizer. The pooled forest plot (Fig) also suggested that DAPT had superior effect over MAPT in reducing mortality of PAD patients.…”

Section: Replymentioning

confidence: 99%

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Mohamed

Patel

et al. 2018

Journal of Vascular Surgery

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“…Patency rates of BBF have been shown to be better if the AVF is created when the patient is pre-dialysis. 20 However, given the morbidity associated with the complex, complicated BBF procedure, this calls into question whether preemptive BBF creation in every patient is appropriate. In particular, more than half of the patients who did not use their AVF due to stabilization of renal function were over the age of 70 years.…”

Section: Utilization Of Avfmentioning

confidence: 99%

“…A recent Scottish study has demonstrated comparable functional patency rates from one and two-stage procedures. 20 As with other series the complication rate and morbidity associated with minimising these complications is paramount. Interestingly, although the primary functional and secondary patency rates of BBF were comparable to BCF in our series, the primary assisted patency rate was lower.…”

Section: Utilization Of Avfmentioning

confidence: 99%

Brachiobasilic fistulae: an upper limb autologous option for everyone?

et al. 2016

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Purpose Autologous arteriovenous fistulae (AVF) are the vascular access option of choice. However, Brachiobasilic fistula (BBF) are complex procedures with variable outcomes reported in the literature. Our aim was to evaluate outcomes and morbidity associated with BBF in our population. Methods Retrospective analysis of prospectively collected data was undertaken for all 51 BBF created in our institution between January 2010 and March 2013. These were compared to an age and sex-matched group of brachiocephalic fistula (BCF) created over a similar time period. Demographic, operative and outcome data was collected for all patients. The primary end points were primary functional patency, primary-assisted patency and secondary patency at 3, 6 and 12 months. Continuous data was compared using Student's t-test and categorical data using chisquared test (p50.05 is significant). Results Mean patient age was 57 years (range: 21-82). About 45% were male. About 73% of patients were already on hemodialysis (HD) at the time of BBF creation. BBF was the secondary or tertiary access procedure in 60.8% of patients (n ¼ 31). BBF were associated with significant operative burden with 82% of patients requiring a general anaesthetic and median hospital admission of 2 days (range: 1-4). About 75% had a single-stage procedure. About 23.5% (n ¼ 12) required operative revision (superficialization or anastomotic revision for stenosis). Patients with BBF spent an additional 3.45 days/year in hospital as a result of access related complications compared to 0.56 days/year in the BCF group. Primary-assisted patency at 3, 6 and 12 months was better in the BCF group than BBF group (86%, 72% and 48% vs. 71%, 59%, 33%, respectively; p50.01) Primary functional and secondary patency rates at 3, 6 and 12 months were 74%, 58% and 32% and 78%, 63% and 41%, respectively, with an average of 0.33 procedures per AVF to maintain patency (10 fistuloplasties, 4 IR thrombectomy and 3 surgical thrombectomy). About 32% (n ¼ 17) of BBF were never used for HD (seven patients had a patent AVF but did not require HD418 months following creation; nine failed to adequately mature and one patient refused second stage superficialization). Conclusions BBF are associated with a significant initial operative burden and higher complication and poorer patency rates than BCF. About one-third of BBF created in this series were never used. Given the morbidity associated with this procedure, careful consideration should be given to creation of BBF in pre-dialysis patients particularly those in whom the rate of decline in renal function is slow. ARTICLE HISTORY

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Brachiobasilic Fistula Formation – Single versus Two Stage Procedure

Abstract: We identified no significant difference of patency between the two methods. This implies that a single stage procedure has benefits, by offering a quicker form of vascular access. Patients who had their fistulae created prior to dialysis had improved patency rates.

Cited by 16 publications

References 16 publications

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

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

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Brachiobasilic fistulae: an upper limb autologous option for everyone?

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