Wang Shouwen, Wang Michele S, Jennings William C
AKDHC Surgery Center, Arizona Kidney Disease and Hypertension Center, Phoenix, Ariz.
AKDHC Surgery Center, Arizona Kidney Disease and Hypertension Center, Phoenix, Ariz.
J Vasc Surg. 2017 Apr;65(4):1104-1112. doi: 10.1016/j.jvs.2016.10.081. Epub 2016 Dec 29.
Basilic vein arteriovenous fistulas are an important and common option for hemodialysis access and require superficialization before use. Various superficialization techniques have been employed, such as basilic tunnel transposition (BTT), basilic elevation, and basilic elevation transposition (BET). Each technique may have advantages and disadvantages, and there have been few reports directly comparing the outcomes of these techniques. This report compares the clinical outcomes of BET vs BTT performed by a single operator and discusses some technical considerations derived from this study and the literature.
The demographic and outcome data of patients who underwent second-stage basilic vein transposition at an ambulatory surgery center from February 2009 to January 2016 were collected and analyzed.
Of the 99 patients identified, 53% were male and 64% were diabetic; the mean age was 61 ± 16 years; 27 had BTT and 72 had BET; the mean follow-up was 26.2 ± 20.5 (range, 1-83) months. The primary patency, assisted primary patency, and secondary patency rates of the whole fistula conduit were 26%, 91%, and 100% for the BTT group and 46%, 98%, 100% for the BET group at 1 year and 21%, 80%, 94% for the BTT group and 38%, 98%, 98% for the BET group at 2 years. The primary patency rate of the basilic vein (segment of the fistula conduit superficialized by transposition) at 1 year was significantly lower for the BTT group vs the BET group (26% vs 61%; P = .004). The average number of percutaneous interventions required for the basilic vein was significantly more for the BTT group vs the BET group (1.5 ± 1.3 vs 0.6 ± 1.0/access-year; P = .007). Based on a Cox regression analysis, the surgical techniques were the only clinical factor that significantly affected the basilic vein primary patency (hazard ratio of 2.28 in favor of BET over BTT; 95% confidence interval, 1.25-4.14; P = .007).
BET is a reliable approach that yields a high cumulative fistula survival rate. Compared with BTT, BET is associated with improved basilic vein primary patency and reduced need for endovascular interventions.
贵要静脉动静脉内瘘是血液透析通路的一种重要且常用的选择，使用前需要进行浅表化处理。已经采用了多种浅表化技术，如贵要静脉隧道转位术（BTT）、贵要静脉抬高术和贵要静脉抬高转位术（BET）。每种技术可能都有其优缺点，并且很少有报告直接比较这些技术的效果。本报告比较了由单一操作者进行的BET与BTT的临床效果，并讨论了从本研究及文献中得出的一些技术要点。
收集并分析了2009年2月至2016年1月在一家门诊手术中心接受二期贵要静脉转位术患者的人口统计学和治疗效果数据。
在确定的99例患者中，53%为男性，64%患有糖尿病；平均年龄为61±16岁；27例行BTT，72例行BET；平均随访时间为26.2±20.5（范围1 - 83）个月。1年时，BTT组整个内瘘管道的初次通畅率、辅助初次通畅率和二次通畅率分别为26%、91%和100%，BET组分别为46%、98%和100%；2年时，BTT组分别为21%、80%和94%，BET组分别为38%、98%和98%。1年时，BTT组贵要静脉（通过转位浅表化的内瘘管道节段）的初次通畅率显著低于BET组（26%对61%；P = .004）。BTT组贵要静脉所需的经皮干预平均次数显著多于BET组（1.5±1.3对0.6±1.0/通路年；P = .007）。基于Cox回归分析，手术技术是唯一显著影响贵要静脉初次通畅率的临床因素（BET相对于BTT的风险比为2.28；95%置信区间，1.25 - 4.14；P = .007）。
BET是一种可靠的方法，可产生较高的内瘘累积生存率。与BTT相比，BET可提高贵要静脉的初次通畅率，并减少血管内干预的需求。
