Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye Cd No 13, Istanbul, Turkey.
Ther Apher Dial. 2021 Oct;25(5):636-641. doi: 10.1111/1744-9987.13610. Epub 2021 Jan 13.
The brachiobasilic transposition (BBT) arteriovenous fistula (AVF) is a valuable option especially for dialysis patients with previously failed vascular access. We aim to report factors affecting the maturation of BBT-AVF created with either one-stage or two-stage technique. BBT-AVF procedures between January 2015 and May 2019 by a dedicated vascular access team were investigated retrospectively. A total of 122 patients (63 males, 59 females), with 6 to 12 weeks of follow-up after the BBT-AVF procedure were included in the study. Patients of one-stage and two-stage techniques were compared for maturation rates. Patients with successful and failed maturation were compared for baseline characteristics and anatomic factors. Of 122 BBT-AVF procedures, 54 were created with the one-stage and 68 were created with the two-stage technique. The mean age of the patients was 58.2 ± 13.8, the mean brachial artery and basilic vein diameters were 3.91 ± 1.02 mm, and 3.39 ± 1.16 mm. Of 122 included patients, 88 (72.1%) had mature AVFs at follow-up. The AVF maturation rates were similar between the one- and two-stage groups (70.4% vs 73.5%; P = .699). Lower age (62.8 ± 12.5 vs 56.5 ± 13.9; P = .023) and greater brachial artery diameter (3.09 ± 0.84 mm vs 4.23 ± 1.76 mm; P < .048) were the only factors affecting the AVF maturation in univariate analysis. Gender, extremity side, diabetes mellitus, hypertension, and targeted vein diameter were not found to affect the AVF maturation (P = .301, P = .084, P = .134, P = .858, P = .127). Target artery diameter (P = .049) was the only significant factor affecting BBT-AVF maturation in multivariate analysis. One-stage and two-stage BBT-AVFs are similar in terms of maturation rates. Targeted artery diameter was the only factor important in BBT-AVF maturation in our study group. The two-stage technique can be preferred considering smaller incision size and lower complication rate in patients with suitable anatomy.
肱动脉-贵要静脉转位（BBT）动静脉瘘（AVF）是一种有价值的选择，特别是对于先前血管通路失败的透析患者。我们旨在报告影响一期和两期技术创建的 BBT-AVF 成熟的因素。回顾性调查了 2015 年 1 月至 2019 年 5 月期间由专门的血管通路团队进行的 BBT-AVF 手术。共有 122 名患者（63 名男性，59 名女性），在 BBT-AVF 手术后 6 至 12 周进行了随访。比较了一期和两期技术患者的成熟率。比较了成熟和未成熟患者的基线特征和解剖因素。在 122 例 BBT-AVF 手术中，54 例采用一期技术，68 例采用两期技术。患者的平均年龄为 58.2±13.8 岁，肱动脉和贵要静脉的平均直径分别为 3.91±1.02mm 和 3.39±1.16mm。在纳入的 122 名患者中，88 名（72.1%）在随访时出现成熟的 AVF。一期和两期组的 AVF 成熟率相似（70.4%比 73.5%；P=0.699）。年龄较小（62.8±12.5 岁比 56.5±13.9 岁；P=0.023）和肱动脉直径较大（3.09±0.84mm 比 4.23±1.76mm；P<0.048）是单因素分析中唯一影响 AVF 成熟的因素。性别、肢体侧、糖尿病、高血压和目标静脉直径均未发现影响 AVF 成熟（P=0.301，P=0.084，P=0.134，P=0.858，P=0.127）。靶动脉直径（P=0.049）是多因素分析中唯一影响 BBT-AVF 成熟的重要因素。一期和两期 BBT-AVF 在成熟率方面相似。在我们的研究组中，目标动脉直径是 BBT-AVF 成熟的唯一重要因素。在具有合适解剖结构的患者中，两期技术可以优先考虑，因为切口较小，并发症发生率较低。
