Mauro Raffaella, Pini Rodolfo, Bianchini Massoni Claudio, Donati Gabriele, Faggioli Gianluca, Gargiulo Mauro, Freyrie Antonio, La Manna Gaetano, Stella Andrea
Vascular Surgery Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Nephrology, Dialysis and Renal Transplantation Unit, University of Bologna, Bologna, Italy.
Artif Organs. 2017 Jun;41(6):539-544. doi: 10.1111/aor.12788. Epub 2016 Nov 21.
Two-stage transposed brachiobasilic arteriovenous fistula is a common procedure after brachiobasilic fistula (BBF) creation. Different techniques can be used for basilic vein transposition but few comparative literature reports are available. The aim of our study was to compare two different techniques for basilic vein transposition. The first maintains the BBF anastomosis and the basilic vein is placed in a subcutaneous pocket (BBAVF). The second transects the basilic vein at the BBF anastomosis and tunnels it superficially, with a new BBF in the brachial artery (BBAVFTn). From 2009 to 2014, all patients who underwent basilic vein superficialization were treated by one of the two techniques, recorded in a dedicated database and retrospectively reviewed. The surgeon chose the technique on the basis of personal preference. The two techniques were compared in terms of perioperative complications, length of hospital stay, time of cannulation, ease of cannulation, and long-term patency. Eighty patients were included in the study: 40 (50%) BBAVF and 40 (50%) BBAVFTn. Length of hospital stay was similar in the two groups (median [interquartile range-IQR] 3(2) [BBAVF] vs. 2(1) [BBAVFTn], P = 0.52, respectively). BBAVFTn was associated with a lower hematoma incidence (1/40 [2.5%] vs. 15/40 [37.5%], P = 0.01), shorter first cannulation time (median IQR: 11(10) vs. 23(8) days, P = 0.01) and easier cannulation compared with BBAVF (32/40 [80%] vs. 15/40 [37.5%], P < 0.001). Median (IQR) follow-up was 16(7) months. No statistical differences in terms of primary and assisted primary patency were found in BBAVFTn vs. BBAVF (at 24 months 91(5) vs. 71(7), P = 0.21 and 93(6) vs. 78(8), P = 0.33, respectively). Patients who underwent BBAVFTn surgery showed fewer surgical complications, better dialytic performance, and easier cannulation compared with those submitted to BBAVF.
两阶段转位肱动脉-贵要静脉内瘘是建立肱动脉-贵要静脉内瘘（BBF）后的常见手术。贵要静脉转位可采用不同技术，但比较性文献报道较少。我们研究的目的是比较两种不同的贵要静脉转位技术。第一种方法是保留BBF吻合口，将贵要静脉置于皮下囊袋（BBAVF）。第二种方法是在BBF吻合口处横断贵要静脉，并使其在皮下隧道潜行，在肱动脉处建立新的BBF（BBAVFTn）。2009年至2014年，所有接受贵要静脉表浅化的患者均采用这两种技术之一进行治疗，并记录在专用数据库中进行回顾性分析。外科医生根据个人偏好选择技术。比较两种技术在围手术期并发症、住院时间、首次穿刺时间、穿刺难易程度及长期通畅率方面的差异。80例患者纳入研究：40例（50%）采用BBAVF，40例（50%）采用BBAVFTn。两组住院时间相似（中位数[四分位间距-IQR]分别为3（2）天[BBAVF]和2（1）天[BBAVFTn]，P = 0.52）。与BBAVF相比，BBAVFTn的血肿发生率较低（1/40 [2.5%] 对15/40 [37.5%]，P = 0.01），首次穿刺时间较短（中位数IQR：11（10）天对23（8）天，P = 0.01），穿刺更容易（32/40 [80%] 对15/40 [37.5%]，P < 0.001）。中位（IQR）随访时间为16（7）个月。BBAVFTn与BBAVF在初级通畅率和辅助初级通畅率方面无统计学差异（24个月时分别为91（5）%对71（7）%，P = 0.21和93（6）%对78（8）%，P = 0.33）。与接受BBAVF手术的患者相比，接受BBAVFTn手术的患者手术并发症更少，透析性能更好，穿刺更容易。
