Department of Surgery, Royal Derby Hospital, Uttoxeter Road, DE22 3NE, United Kingdom.
Department of Surgery, Royal Derby Hospital, Uttoxeter Road, DE22 3NE, United Kingdom.
Int J Surg. 2015 Jun;18:71-4. doi: 10.1016/j.ijsu.2015.04.041. Epub 2015 Apr 20.
Vascular access is essential to end-stage renal failure patients requiring haemodialysis. Many patients require multiple fistula formation attempts in order to gain good access, making secondary and tertiary fistula options vital. Brachiobasilic fistulas are well established, but there is little evidence to compare the different surgical techniques in creating them. This study aimed to determine the patency and complication rates associated with these procedures.
Retrospective data was collected by reviewing case notes to determine fistula survival time and surgical setting. Patency, complications and required interventions were recorded for each group at three time intervals. The Kaplan-Meier method was used to calculate survival for each cohort.
37 brachiobasilic arteriovenous fistulas were created in 35 patients. 17 fistulas were one-stage procedures; 20 fistulas were made in two stages. Survival proportions were measured as 70.6%, 58.8% and 51.5% for the one-stage procedure and 95%, 90% and 78% for the two-stage procedure at 1 month, 1 year and 2 years respectively with p = 0.0385.
Native brachiobasilic fistulas have advantages over prosthetic grafts. There are technical aspects which make the two-staged procedure preferable, including being more amenable to a day case surgery setting. Despite this, there is a lack of relative outcome differences in the literature, thus necessitating further work.
Our data suggests creation of brachiobasilic fistulas using a two-staged procedure may result in improved patency rates. Complication rates were found to be statistically equivocal, with fistuloplasties and embolectomy shown to be effective in fistula salvage.
血管通路对于需要血液透析的终末期肾衰竭患者至关重要。许多患者需要多次尝试形成瘘管才能获得良好的通路，因此二级和三级瘘管选择至关重要。肱动脉-桡动脉内瘘已得到广泛应用，但比较不同手术技术在建立内瘘中的作用的证据很少。本研究旨在确定这些手术相关的通畅率和并发症发生率。
通过回顾病历记录来收集回顾性数据，以确定瘘管的生存时间和手术环境。记录每个组在三个时间间隔内的通畅率、并发症和所需干预措施。使用 Kaplan-Meier 方法计算每个队列的生存情况。
35 名患者共创建了 37 个肱动脉-桡动脉内瘘。17 个瘘管为一期手术；20 个瘘管为分期手术。一期手术的生存比例分别为 1 个月、1 年和 2 年时的 70.6%、58.8%和 51.5%，而二期手术的生存比例分别为 95%、90%和 78%，p = 0.0385。
原生肱动脉-桡动脉内瘘优于人工移植物。有一些技术方面使得分期手术更具优势，包括更适合日间手术环境。尽管如此，文献中缺乏相对的结果差异，因此需要进一步的工作。
我们的数据表明，使用分期手术创建肱动脉-桡动脉内瘘可能会提高通畅率。并发症发生率在统计学上是相似的，瘘管成形术和血栓切除术显示对内瘘的挽救有效。
