Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, K-8, 2799 W Grand Boulevard, Detroit, MI 48202, USA.
Eur J Vasc Endovasc Surg. 2010 May;39(5):612-9. doi: 10.1016/j.ejvs.2010.01.006. Epub 2010 Feb 20.
To compare the outcome of the one-stage basilic vein transposition (BVT) fistula with a modified, two-stage technique.
Retrospective case-controlled study, performed in an academic centre.
A total of 173 candidates for BVT fistula (87 males, mean age 61 years).
In one-stage BVT, the basilic vein is mobilised through a single incision, placed inside an anterolateral arm tunnel and anastomosed with the brachial artery. In two-stage procedures, the fistula-arterial anastomosis is created first, followed by the second stage, after fistula maturation several weeks later, when the basilic vein is mobilised through two skip incisions, transected near the anastomosis, placed inside an anterolateral arm tunnel and reanastomosed. Morbidity and fistula maturation rate were the main outcome measures.
In one-stage BVT (n=76), the incidence of venous hypertension, wound haematomas and all complications (17%, 13% and 43%, respectively) was significantly higher than in two-stage procedures (n=98) (4%, p=0.004, 3%, p=0.012 and 11%, p<0.001, respectively). Time (68 days) to fistula use was significantly decreased in one-stage BVT than in two-stage procedures (132 days, p<0.001) but failure to mature rate was equivalent (15% vs. 18%, p=0.49).
Our results indicate that the two-stage BVT fistula through two skip-arm incisions is superior to the established one-stage procedure in terms of less morbidity but at the cost of a second operation and longer time to access use. Further research comparing these two techniques is necessary. Until this issue is resolved, an individualised approach is suggested.
比较一期贵要静脉转位（BVT）造瘘术与改良的两期技术的结果。
回顾性病例对照研究，在学术中心进行。
共 173 名 BVT 造瘘术候选人（87 名男性，平均年龄 61 岁）。
在一期 BVT 中，通过单个切口动员贵要静脉，将其置于前臂前外侧隧道内，并与肱动脉吻合。在两期手术中，首先进行瘘管-动脉吻合，然后在几周后瘘管成熟后进行第二期手术，此时通过两个跳过切口动员贵要静脉，在吻合口附近切断，置于前臂前外侧隧道内并重新吻合。发病率和瘘管成熟率是主要的观察指标。
在一期 BVT 中（n=76），静脉高压、伤口血肿和所有并发症（分别为 17%、13%和 43%）的发生率明显高于两期手术（n=98）（分别为 4%、p=0.004、3%、p=0.012 和 11%、p<0.001）。一期 BVT 的瘘管用时（68 天）明显短于两期手术（132 天，p<0.001），但成熟失败率相当（15%与 18%，p=0.49）。
我们的结果表明，通过两个跳过臂切口的两期 BVT 瘘管在减少发病率方面优于既定的一期手术，但需要进行第二次手术和更长的时间才能使用。需要进一步研究比较这两种技术。在解决这个问题之前，建议采用个体化方法。
