Ozcan Sedat, Gür Ali Kemal, Yener Ali Umit, Odabaşi Dolunay
Department of Cardiovascular Surgery, Çanakkale Onsekiz Mart University, Çanakkale, Turkey.
Cardiovasc J Afr. 2013 Oct-Nov;24(9-10):364-8. doi: 10.5830/CVJA-2013-077.
This study aimed to compare the results of one-and two-stage basilic vein transposition (BVT) in haemodialysis patients.
This was a non-randomised, retrospective study between January 2007 and January 2012 on 96 patients who were diagnosed with end-stage renal failure (ESRF) (54 males, 42 females; mean age 43.6 ± 14 years) and underwent one- or two-stage BVT in our clinic. All patients who were not eligible for a native radio-cephalic or brachio-cephalic arterio-venous fistula (AVF) were scheduled for one- or two-stage BVT after arterial (brachial, radial and ulnar) and venous (basilic and cephalic) Doppler ultrasonography. Patients were retrospectively divided into two groups: group 1, basilic vein diameter > 3 mm and patients who underwent one-stage BVT; and group 2, basilic vein diameter < 3 mm and patients who underwent two-stage BVT. In group 1, the basilic vein with a single incision was anastomosed to the brachial artery, followed by superficialisation. In group 2, the basilic vein was anastomosed to the brachial artery and they underwent the superficialisation procedure one month postoperatively. Fistula maturation and postoperative complications were assessed.
The mean diameter of the basilic vein was statistically significantly higher in group 1 (3.46 ± 0.2 mm) than in group 2 (2.79 ± 0.1 mm) (p < 0.05). In terms of postoperative complications, thrombosis, haemorrhage and haematoma were significantly higher in group 1 (34, 36 and 17%, respectively) than in group 2 (23, 14 and 6%, respectively) (p < 0.05). The rate of fistula maturation was significantly lower in group 1 (66%), compared to group 2 (77%) (p < 0.05).Time to fistula maturation was significantly shorter in group 1 (mean 41 ± 14 days), compared to group 2 (mean 64 ± 28 days) (p < 0.05).
Two-stage BVT was superior to one-stage BVT due to its lower rate of postoperative complications and higher fistula maturation, despite its disadvantage of late fistula use. Although the diameter of the basilic vein was larger in patients who underwent one-stage BVT, we observed that one-stage BVT was disadvantageous in terms of postoperative complications and fistula maturation.
本研究旨在比较血液透析患者一期和二期贵要静脉转位术（BVT）的效果。
这是一项非随机回顾性研究，研究对象为2007年1月至2012年1月间在我院诊断为终末期肾衰竭（ESRF）的96例患者（男54例，女42例；平均年龄43.6±14岁），他们接受了一期或二期BVT。所有不符合自体桡动脉-头静脉或肱动脉-头静脉动静脉内瘘（AVF）条件的患者，在进行动脉（肱动脉、桡动脉和尺动脉）和静脉（贵要静脉和头静脉）多普勒超声检查后，安排进行一期或二期BVT。患者被回顾性分为两组：第1组，贵要静脉直径>3mm且接受一期BVT的患者；第2组，贵要静脉直径<3mm且接受二期BVT的患者。在第1组中，通过单一切口将贵要静脉与肱动脉吻合，然后进行皮下化。在第2组中，将贵要静脉与肱动脉吻合，并在术后1个月进行皮下化手术。评估内瘘成熟情况和术后并发症。
第1组贵要静脉的平均直径（3.46±0.2mm）在统计学上显著高于第2组（2.79±0.1mm）（p<0.05）。在术后并发症方面，第1组的血栓形成、出血和血肿发生率（分别为34%、36%和17%）显著高于第2组（分别为23%、14%和6%）（p<0.05）。第1组内瘘成熟率（66%）显著低于第2组（77%）（p<0.05）。第1组内瘘成熟时间（平均41±14天）显著短于第2组（平均64±28天）（p<0.05）。
二期BVT优于一期BVT，因为其术后并发症发生率较低，内瘘成熟率较高，尽管其缺点是内瘘使用较晚。虽然接受一期BVT的患者贵要静脉直径较大，但我们观察到一期BVT在术后并发症和内瘘成熟方面存在劣势。
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