Sheta Mohamed, Hakmei Jalal, London Mark, Wooster Mathew, Aruny John, Ross John, Illig Karl A
Dialysis Access Institute, The Regional Medical Center, Orangeburg, SC, USA.
Medical University of South Carolina, Charleston, SC, USA.
J Vasc Access. 2020 May;21(3):281-286. doi: 10.1177/1129729819862694. Epub 2019 Aug 1.
In the absence of suitable cephalic vein, the brachiobasilic vein complex represents the best option for arteriovenous access. However, the basilic vein is too deep to cannulate and requires transposition to be accessible. Transposition can be performed during fistula creation (single-stage BBTx) or at a second operation after initial fistula creation (two-stage brachiobasilic transposition (BBTx)). The best approach is unknown. A PubMed search using "Basilic vein transposition" as the primary search term was performed to identify articles addressing this controversy. Meta-analysis was then performed using those papers that provided the inspected data points with student's t-test used to compare maturation and patency rates between the groups. A total of 37 manuscripts were judged of adequate quality for analysis. Based on the available data, overall maturation rates, 1-year primary patency rates, and overall complication rates seem to be equivalent between single- and two-stage BBTx, while 1-year secondary patency is greater in the two-stage group (79% vs 85%). A large prospective randomized clinical trial with clear definitions of maturity, patency, and complications is needed to definitively answer the question of whether one strategy is better than the other.
在没有合适的头静脉时，肱静脉-贵要静脉复合体是动静脉通路的最佳选择。然而，贵要静脉位置太深难以插管，需要移位后才能进行插管。移位可在造瘘时进行（单阶段肱静脉-贵要静脉移位术），或在初次造瘘后的第二次手术中进行（两阶段肱静脉-贵要静脉移位术）。最佳方法尚不清楚。以“贵要静脉移位术”作为主要检索词在PubMed上进行检索，以确定涉及这一争议的文章。然后对那些提供了可检查数据点的论文进行荟萃分析，使用学生t检验来比较两组之间的成熟率和通畅率。共有37篇手稿被判定质量足以进行分析。根据现有数据，单阶段和两阶段肱静脉-贵要静脉移位术的总体成熟率、1年初级通畅率和总体并发症率似乎相当，而两阶段组中1年次级通畅率更高（79%对85%）。需要进行一项大型前瞻性随机临床试验，明确界定成熟度、通畅率和并发症，才能最终回答一种策略是否优于另一种策略的问题。
