Smith George E, Carradice Daniel, Samuel Nehemiah, Gohil Risha, Chetter Ian C
Academic Vascular Surgery Unit, Hull and York Medical School, Yorkshire, UK.
J Vasc Access. 2011 Oct-Dec;12(4):354-7. doi: 10.5301/JVA.2011.8384.
The recommended site for the next autologous vascular access in patients without suitable cephalic vein for fistula formation is basilic vein transposition. This study aims to compare outcomes from great saphenous vein transpositions to the forearm with that of basilic vein transposition. Comparison is reported in terms of primary and secondary patency, intervention, and complication rates in our unit.
A retrospective search of a prospectively maintained vascular database identified 24 consecutive patients undergoing great saphenous vein transposition (GSVT) and 34 consecutive patients having basilic vein transposition (BVT) were included for comparison. Primary and secondary patency details were obtained from hospital case notes and dialysis unit review records. Patency was studied using a Kaplan Meier analysis and compared using log rank testing.
No significant difference was identified in primary or secondary patency between the procedures (P=0.745). Primary patency at 6, 12 and 24 months: for GSVT this was 62%, 41%, and 20%; for BVT this was 44%, 32%, and 15% respectively. Secondary patency at 6, 12, and 24 months; for GSVT this was 75%, 50%, and 41%; for BVT this was 65% respectively. Requirements for intervention were similar between groups. Complications were more common in the BVT group.
Acceptable patency rates can be achieved using GSVT, thus adding another autologous option for upper limb dialysis access. Our results would suggest GSVT could be performed prior to BVT as the basilic vein may benefit from prior partial arterialization and can subsequently be used if GSVT fails.
对于没有合适头静脉用于造瘘的患者，下一次自体血管通路的推荐部位是贵要静脉转位术。本研究旨在比较大隐静脉转位至前臂与贵要静脉转位的效果。报告了我们科室在初次通畅率、二次通畅率、干预措施及并发症发生率方面的比较情况。
对前瞻性维护的血管数据库进行回顾性检索，纳入24例连续接受大隐静脉转位术（GSVT）的患者和34例连续接受贵要静脉转位术（BVT）的患者进行比较。初次和二次通畅的详细情况从医院病历和透析科室复查记录中获取。使用Kaplan-Meier分析研究通畅情况，并使用对数秩检验进行比较。
两种手术在初次或二次通畅方面未发现显著差异（P=0.745）。6个月、12个月和24个月时的初次通畅率：GSVT分别为62%、41%和20%；BVT分别为44%、32%和15%。6个月、12个月和24个月时的二次通畅率：GSVT分别为75%、50%和41%；BVT分别为65%。两组间干预需求相似。并发症在BVT组更常见。
使用GSVT可实现可接受的通畅率，从而为上肢透析通路增加了另一种自体选择。我们的结果表明，GSVT可在BVT之前进行，因为贵要静脉可能会从先前的部分动脉化中受益，并且如果GSVT失败，随后可使用贵要静脉。
