Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The CS Mott Children's Hospital, Ann Arbor, MI, USA.
J Pediatr Surg. 2010 Jan;45(1):177-84; discussion 184. doi: 10.1016/j.jpedsurg.2009.10.029.
The fistula first initiative has led to increased efforts to create arteriovenous fistulas (AVFs) as primary dialysis access. Two-stage basilic vein transposition (BVT) allows maturation of smaller veins, often a limiting factor in the pediatric population, before elevation and use. We sought to determine whether using 2-stage BVT improves maturation, use, and patency compared with other AVFs, including arteriovenous (AV) grafts.
Thirty-one patients underwent AV access creation between 1997 and 2008. Data were collected on types of access, maturation, complications, and patency.
Forty-two AV access procedures were performed: 15 (36%) 2-stage BVT, 13 (31%) 1-stage BVT, 6 (14%) radiocephalic, 3 (7%) brachiocephalic, 1 (2%) brachiobrachial, and 4 (10%) AV grafts. Follow-up averaged 20.4 +/- 3.2 months for 2-stage BVT and 47.9+/-4.1 months for other AVFs (P < .001). All 2-stage BVT matured compared with 52% (14/27) of other AVFs (P = .001). More 2-stage BVTs (87%) were used for dialysis than other AVFs (48%, P = .024). Fistula failure occurred in 7% 2-stage BVT compared with 59% other AVFs (P = .001). One-year patency rates were 91% for 2-stage BVT vs 47% for other AVFs (P = .003).
Rates of fistula maturation, use, and patency are higher for 2-stage BVT with lower rates of failure. Two-stage BVT shows great promise as the preferred approach to creation of AVF in pediatric patients, especially those with smaller veins.
fistula first 倡议促使人们加大力度创建动静脉瘘（AVF）作为主要透析通路。二期肱静脉转位术（BVT）可使较小的静脉成熟，这在儿科人群中常常是一个限制因素，然后再将其提升并使用。我们试图确定与其他动静脉（AV）移植物等其他 AVF 相比，使用两阶段 BVT 是否能改善成熟度、使用率和通畅率。
1997 年至 2008 年间，31 例患者接受了血管通路的建立。收集了通路类型、成熟度、并发症和通畅率的数据。
共进行了 42 次 AV 通路手术：15 例（36%）为两阶段 BVT，13 例（31%）为单阶段 BVT，6 例（14%）为桡动脉-头静脉，3 例（7%）为肱动脉-头静脉，1 例（2%）为肱动脉-肱静脉，4 例（10%）为 AV 移植物。两阶段 BVT 的平均随访时间为 20.4+/-3.2 个月，其他 AVF 为 47.9+/-4.1 个月（P<.001）。所有两阶段 BVT 均成熟，而其他 AVF 的成熟率为 52%（14/27）（P=.001）。与其他 AVF（48%，P=.024）相比，更多的两阶段 BVT（87%）用于透析。两阶段 BVT 的瘘管失败率为 7%，而其他 AVF 为 59%（P=.001）。两阶段 BVT 的 1 年通畅率为 91%，而其他 AVF 为 47%（P=.003）。
两阶段 BVT 的瘘成熟、使用和通畅率较高，失败率较低。两阶段 BVT 为儿科患者创建 AVF 提供了一种很有前途的方法，特别是对于那些静脉较小的患者。
