Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Vasc Surg. 2019 Apr;69(4):1180-1186. doi: 10.1016/j.jvs.2018.06.220. Epub 2018 Oct 24.
Radial-cephalic arteriovenous fistula and brachial-cephalic arteriovenous fistula are the first and second choices for creating vascular access in dialysis patients as recommended by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Basilic vein transposition or use of a forearm (polytetrafluoroethylene [PTFE]) loop graft is recommended thereafter. The aim of this study was twofold: first, to compare the outcomes and patency rates of patients treated with a basilic vein transposition with those of patients treated with a PTFE loop; and second, to identify patient-related factors of influence on patency rates.
Data collected in our prospectively maintained database of patients with chronic renal dysfunction requiring hemodialysis were analyzed. From April 2006 to August 2017, there were 55 patients with a basilic vein transposition and 75 patients with a PTFE loop included. Primary, primary assisted, and secondary patency rates were calculated. Multivariate analysis was used to identify factors of influence on survival. Incidence rates of complications and reinterventions were calculated and compared.
Mean follow-up time was 29 months. A significantly higher 2-year primary assisted patency rate was found for the basilic vein transposition group (72.7% ± 6.5% vs 47.6% ± 6.2%; P < .01). The 2-year primary patency rates and secondary patency rates were comparable between basilic vein transposition and PTFE loop (25.1% ± 6.6% vs 13.7% ± 4.4% [P = .11] and 75.5% ± 6.5% vs 73.9% ± 5.3% [P = .17], respectively). Cox regression identified body mass index (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.05-2.98; P = .03) and age (HR, 0.54; 95% CI, 0.32-0.91; P = .02) as predictors for failure regarding primary patency in PTFE loop patients. Previous catheter use (HR, 0.29; 95% CI, 0.12-0.70; P = .006) and the presence of diabetes (HR, 3.32; 95% CI, 1.50-7.39; P = .003) were independent predictors for failure regarding primary patency in basilic vein transposition patients. The incidence rate of total complications was significantly higher in the PTFE loop group with 0.70 per patient-year (PY) compared with 0.28 PY in the basilic vein transposition group (P = .001). In terms of intervention rate, a significantly higher percutaneous transluminal angioplasty rate and surgical revision rate were found in the PTFE loop group than in the basilic vein transposition group (1.77 PY vs 1.05 PY [P = .022] and 0.20 PY vs 0.07 PY [P = .002], respectively).
In this nonrandomized study, basilic vein transposition has better primary assisted patency, fewer complications, and fewer reinterventions compared with PTFE loop.
根据美国肾脏病基金会肾脏病预后质量倡议的建议，桡动脉-头静脉动静脉瘘和肱动脉-头静脉动静脉瘘是透析患者建立血管通路的首选和次选方法。此后建议转位贵要静脉或使用前臂（聚四氟乙烯 [PTFE]）环移植物。本研究的目的有两个：首先，比较转位贵要静脉和使用 PTFE 环的患者的治疗结果和通畅率；其次，确定影响通畅率的患者相关因素。
分析了我们前瞻性维护的需要血液透析的慢性肾功能不全患者数据库中收集的数据。2006 年 4 月至 2017 年 8 月，共有 55 例患者接受了贵要静脉转位，75 例患者接受了 PTFE 环。计算了主要、辅助主要和次要通畅率。采用多变量分析确定对生存有影响的因素。计算并比较了并发症和再干预的发生率。
平均随访时间为 29 个月。贵要静脉转位组的 2 年辅助主要通畅率显著较高（72.7%±6.5%比 47.6%±6.2%；P<.01）。贵要静脉转位和 PTFE 环的 2 年主要通畅率和次要通畅率相当（25.1%±6.6%比 13.7%±4.4%[P=.11]和 75.5%±6.5%比 73.9%±5.3%[P=.17]）。Cox 回归分析确定体重指数（危险比[HR]，1.77；95%置信区间[CI]，1.05-2.98；P=.03）和年龄（HR，0.54；95%CI，0.32-0.91；P=.02）是 PTFE 环患者主要通畅失败的预测因素。既往使用导管（HR，0.29；95%CI，0.12-0.70；P=.006）和患有糖尿病（HR，3.32；95%CI，1.50-7.39；P=.003）是贵要静脉转位患者主要通畅失败的独立预测因素。PTFE 环组的总并发症发生率明显较高，为 0.70 人年（PY），而贵要静脉转位组为 0.28 PY（P=.001）。在干预率方面，PTFE 环组经皮腔内血管成形术和手术修订率明显高于贵要静脉转位组（1.77 PY 比 1.05 PY[P=.022]和 0.20 PY 比 0.07 PY[P=.002]）。
在这项非随机研究中，与 PTFE 环相比，贵要静脉转位具有更好的辅助主要通畅率、更少的并发症和更少的再干预。
