John A. Burns School of Medicine, Honolulu, HI, USA.
Department of Surgery, Pali Momi Medical Center, Aiea, HI, USA.
J Vasc Access. 2022 Nov;23(6):904-910. doi: 10.1177/11297298211015095. Epub 2021 May 15.
Long-term hemodialysis (HD) treatment requires the establishment of a cannulatable vascular access (VA) point. While the arteriovenous fistula (AVF) is considered the gold standard, the arteriovenous graft (AVG) is a viable alternative especially in patients with poor superficial venous anatomy. Few studies have assessed the efficacy of the brachial-brachial arteriovenous graft (BB-AVG) for long-term HD access. By analyzing one surgeon's experience in creating, surveilling and maintaining BB-AVGs, this retrospective study aims to add to the body of literature in assessing patency outcomes of BB-AVGs.
We identified 57 BB-AVGs that met inclusion criteria and were created between October 6, 2005 and May 1, 2019 by a single surgeon in 54 patients. We analyzed primary failures, patency, complications and interventions. Patency rates were calculated by the Kaplan-Meier method. The incidence of complications and interventions were expressed as number of events per person-year.
A total of 54 patients (median age of 65 years) were analyzed. Primary patency rates at 12, 24, and 36 months were 20.4% 7.4%, and 5.0%. Primary assisted patency rates at 12, 24, and 36 months were 46.7%, 33.5%, and 15.1%. The secondary patency rates at 12, 24, and 36 months were 81.8%, 63.8%, and 60.1%, respectively. The incidence of complications and interventions was 2.164 per person-year. Most complications and interventions were due to stenosis (1.202 per person-year) or thrombosis (0.802 per person-year).
In patients with poor superficial veins, the brachial vein is a reasonable alternative to use as the venous outflow. However, in order to achieve acceptable patency rates, close monitoring of the VA, as well as aggressive treatment of complications within the brachial vein is necessary. Overall, the BB-AVG should be considered in patients who lack adequate superficial veins and require preservation of the more proximal veins.
长期血液透析（HD）治疗需要建立可插管的血管通路（VA）点。动静脉瘘（AVF）被认为是金标准，而动静脉移植物（AVG）是一种可行的替代方法，尤其是在浅静脉解剖结构不良的患者中。很少有研究评估肱动脉-肱动脉动静脉移植物（BB-AVG）用于长期 HD 通路的效果。通过分析一位外科医生在创建、监测和维持 BB-AVG 方面的经验，这项回顾性研究旨在为评估 BB-AVG 的通畅结果的文献提供补充。
我们确定了符合纳入标准的 57 个 BB-AVG，这些 AVG 是由一位外科医生在 54 名患者中于 2005 年 10 月 6 日至 2019 年 5 月 1 日期间创建的。我们分析了原发性失败、通畅性、并发症和干预措施。通畅率通过 Kaplan-Meier 法计算。并发症和干预措施的发生率以每患者年发生的事件数表示。
共分析了 54 名患者（中位年龄 65 岁）。12、24 和 36 个月时的原发性通畅率分别为 20.4%、7.4%和 5.0%。12、24 和 36 个月时的原发性辅助通畅率分别为 46.7%、33.5%和 15.1%。12、24 和 36 个月时的继发性通畅率分别为 81.8%、63.8%和 60.1%。并发症和干预措施的发生率为每患者年 2.164 次。大多数并发症和干预措施是由于狭窄（1.202 次/患者年）或血栓形成（0.802 次/患者年）引起的。
在浅静脉较差的患者中，肱静脉是静脉流出的合理选择。然而，为了获得可接受的通畅率，需要密切监测 VA，并积极治疗肱静脉中的并发症。总体而言，对于缺乏足够的浅静脉且需要保留更近端静脉的患者，应考虑使用 BB-AVG。
