Bashar Khalid, Healy Donagh A, Elsheikh Sawsan, Browne Leonard D, Walsh Michael T, Clarke-Moloney Mary, Burke Paul E, Kavanagh Eamon G, Walsh Stewart R
Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
Department of Acute Medicine, James Connolly Memorial Hospital, Dublin, Ireland.
PLoS One. 2015 Mar 9;10(3):e0120154. doi: 10.1371/journal.pone.0120154. eCollection 2015.
A brachiobasilic arteriovenous fistula (BB-AVF) can provide access for haemodialysis in patients who are not eligible for a more superficial fistula. However, it is unclear whether one- or two-stage BB-AVF is the best option for patients.
To systematically assess the difference between both procedures in terms of access maturation, patency and postoperative complications.
Online search for randomised controlled trials (RCTs) and observational studies that compared the one-stage versus the two-stage technique for creating a BB-AVF.
Eight studies were included (849 patients with 859 fistulas), 366 created using a one-stage technique, while 493 in a two-stage approach. There was no statistically significant difference between the two groups in the rate of successful maturation (Pooled risk ratio = 0.95 [0.82, 1.11], P = 0.53). Similarly, the incidence of postoperative haematoma (Pooled risk ratio = 0.73 [0.34, 1.58], P = 0.43), wound infection (Pooled risk ratio = 0.77 [0.35, 1.68], P = 0.51) and steal syndrome (Pooled risk ratio = 0.65 [0.27, 1.53], P = 0.32) were statistically comparable.
Although more studies seem to favour the two-stage BVT approach, evidence in the literature is not sufficient to draw a final conclusion as the difference between the one-stage and the two-stage approaches for creation of a BB-AVF is not statistically significant in terms of the overall maturation rate and postoperative complications. Patency rates (primary, assisted primary and secondary) were comparable in the majority of studies. Large randomised properly conducted trials with superior methodology and adequate sub-group analysis are needed before making a final recommendation.
肱动脉-贵要静脉动静脉内瘘（BB-AVF）可为不适合建立更浅表内瘘的患者提供血液透析通路。然而，对于患者而言，一期还是二期BB-AVF是最佳选择尚不清楚。
系统评估两种手术方式在通路成熟度、通畅率及术后并发症方面的差异。
在线检索比较一期与二期技术建立BB-AVF的随机对照试验（RCT）和观察性研究。
纳入8项研究（849例患者，859条内瘘），其中366条采用一期技术建立，493条采用二期技术建立。两组在成功成熟率方面无统计学显著差异（合并风险比=0.95[0.82,1.11]，P=0.53）。同样，术后血肿发生率（合并风险比=0.73[0.34,1.58]，P=0.43）、伤口感染发生率（合并风险比=0.77[0.35,1.68]，P=0.51）和窃血综合征发生率（合并风险比=0.65[0.27,1.53]，P=0.32）在统计学上具有可比性。
尽管更多研究似乎倾向于二期BVT方法，但文献中的证据不足以得出最终结论，因为就总体成熟率和术后并发症而言，一期与二期建立BB-AVF方法之间的差异无统计学意义。大多数研究中，通畅率（初级、辅助初级和次级）具有可比性。在做出最终推荐之前，需要进行方法更优且有充分亚组分析的大型随机对照试验。
