School of Medicine, College of Medicine, 38032Taipei Medical University, Taipei.
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, 38032Taipei Medical University, New Taipei City.
Vasc Endovascular Surg. 2021 Feb;55(2):164-170. doi: 10.1177/1538574420969252. Epub 2020 Nov 24.
Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis.
A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions.
Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001).
Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.
为长期血液透析患者创建和维护功能正常的动静脉通路至关重要。当无法创建或桡动脉-头静脉内瘘或肱动脉-头静脉内瘘失败时，转位肱动脉-贵要静脉内瘘（BBF）或动静脉移植物（AVG）成为一种选择。本研究比较了血液透析患者中 BBF 和 AVG 的通畅率和并发症。
这项回顾性研究于 2015 年 11 月至 2020 年 5 月在台湾双和医院进行。所有手术均由一位外科医生完成。主要结局是 BBF 和 AVG 组的初始通畅率、初始辅助通畅率和次级通畅率。次要结局是并发症和再干预的发生率。
在 144 例连续患者中，20 例和 124 例分别接受了 BBF 和 AVG 手术。中位随访时间为 19.2 个月。BBF 组的 1 年和 2 年初始通畅率分别为 67%和 19%，AVG 组分别为 44%和 16%（P = 0.126）。BBF 组的 1 年和 2 年初始辅助通畅率分别为 82%和 54%，AVG 组分别为 54%和 30%（P = 0.012）。BBF 组的 1 年和 2 年次级通畅率分别为 100%和 82%，AVG 组分别为 81%和 67%（P = 0.078）。AVG 组的并发症发生率明显高于 BBF 组（1.7 例/患者年与 0.93 例/患者年，P < 0.001）。
与 AVG 组相比，BBF 组具有更好的初始辅助通畅率、更低的并发症和干预率。因此，如果贵要静脉可用于重建，BBF 是头静脉耗竭患者的可靠选择。
