Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
J Vasc Surg. 2011 Jun;53(6):1632-8; discussion 1639. doi: 10.1016/j.jvs.2011.01.064. Epub 2011 Apr 30.
Brachiobasilic arteriovenous fistulas (BBAVF) can be performed in one or two stages. We compared primary failure rates, as well as primary and secondary patency rates of one- and two-stage BBAVF at two institutions.
Patients undergoing one- and two-stage BBAVF at two institutions were compared retrospectively with respect to age, sex, body mass index, use of preoperative venous duplex ultrasound, diabetes, hypertension, and cause of end-stage renal disease. Categorical variables were compared using chi-square and Fisher's exact test, whereas the Wilcoxon rank-sum test was used to compare continuous variables. Patency rates were assessed using the Kaplan-Meier survival analysis and the Cox proportional hazards model with propensity analysis to determine hazard ratios.
Ninety patients (60 one-stage and 30 two-stage) were identified. Mean follow-up was 14.2 months and the mean time interval between the first and second stage was 11.2 weeks. Although no significant difference in early failure existed (one-stage, 22.9% vs two-stage, 9.1%; P = .20), the two-stage BBAVF showed significantly improved primary functional patency at 1 year at 88% vs 61% (P = .047) (hazard ratio, 0.2 (95% confidence interval [CI], .04-.80; P = .03). Patency for one-stage BBAVF markedly decreased to 34% at 2 years compared with 88% for the two-stage procedure (P = .047). Median primary functional patency for one-stage BBAVF was 31 weeks (interquartile range [IQR], 11-54) vs 79 weeks (IQR, 29-131 weeks) for the two-stage procedure, respectively (P = .0015). Two-year secondary functional patency for one- and two-stage procedures were 41% and 94%, respectively (P = .015).
Primary and secondary patency at 1 and 2 years as well as functional patency is improved with the two-stage BBAVF when compared with the one-stage procedure. Lower primary failure rates prior to dialysis with the two-stage procedure approached, but did not reach statistical significance. While reasons for these finding are unclear, certain technical aspects of the procedure may play a role.
肱动脉-头静脉动静脉瘘（BBAVF）可分一期或两期进行。我们比较了两家机构中一期和两期 BBAVF 的初次失败率以及初次和继发性通畅率。
我们回顾性比较了在两家机构中接受一期和两期 BBAVF 的患者的年龄、性别、体重指数、术前静脉双功超声的使用、糖尿病、高血压和终末期肾病的病因。分类变量采用卡方检验和 Fisher 确切概率法进行比较，而连续变量采用 Wilcoxon 秩和检验进行比较。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型进行通畅率评估，并进行倾向评分分析以确定风险比。
共纳入 90 例患者（60 例一期，30 例两期）。平均随访时间为 14.2 个月，第一期和第二期之间的平均时间间隔为 11.2 周。虽然早期失败率没有显著差异（一期为 22.9%，两期为 9.1%；P =.20），但两期 BBAVF 在 1 年时的原发性功能通畅率显著提高，为 88%，而一期为 61%（P =.047）（风险比，0.2（95%置信区间 [CI]，0.04-0.80；P =.03）。与两期手术相比，一期 BBAVF 的通畅率在 2 年时显著下降至 34%（P =.047）。一期 BBAVF 的中位原发性功能通畅率为 31 周（四分位间距 [IQR]，11-54），而两期手术的通畅率为 79 周（IQR，29-131 周）（P =.0015）。一期和两期手术的 2 年继发性功能通畅率分别为 41%和 94%（P =.015）。
与一期手术相比，两期 BBAVF 在 1 年和 2 年时的原发性和继发性通畅率以及功能通畅率均有所提高。两期手术在透析前的初次失败率较低，但未达到统计学意义。虽然这些发现的原因尚不清楚，但手术的某些技术方面可能发挥了作用。
