Welander Gunilla, Lundin Fredrik, Palanjafi Hawshin, Sigvant Birgitta
Department of Medical Sciences, Uppsala University, Uppsala, and Department of Nephrology, Central Hospital Karlstad, Karlstad, Region Värmland, Sweden.
Centre of Clinical Research, Karlstad, Region Värmland, Sweden.
Eur J Vasc Endovasc Surg. 2025 Jun;69(6):889-896. doi: 10.1016/j.ejvs.2024.12.027. Epub 2024 Dec 18.
Creation of a brachiobasilic arteriovenous fistula (BBAVF) can be performed as either a one or two stage procedure; however, evidence for the best technique is conflicting. The aim of this national registry review was to determine whether functional outcomes favoured either method.
This was a retrospective observational study with data from the Swedish Renal Registry. BBAVFs created in patients aged ≥ 18 years between 2011 and 2019 were included and were categorised as one stage (BB1) or two stage (BB2). Outcome, patency, and complications were captured from creation onwards, as were all open and endovascular repeat procedures.
BB1s (n = 224) were more common than BB2s (n = 83). Of the BB2s, 66 (80%) were transposed in the second stage. The most common reason for not performing transposition was occlusion (n = 10). The median follow up was two years (interquartile range [IQR] 0.8, 4.2). Overall, 31% of BBAVFs were never used. Vein stenosis was common, seen in 157 BB1s (70%) and 40 BB2s (48%). The incidence of endovascular interventions per patient year was two times higher in BB1s than BB2s (0.6 vs. 0.3). Primary patency at one year was 39% and 54% in BB1 and BB2, respectively (p = .002). Secondary patency at one and three years was similar between groups (BB1 81% and 69%, and BB2 82% and 78%; p = .14). Diabetes as a comorbidity and female sex were associated with worse patency, but body mass index ≥ 30 kg/m was not. Creation pre-dialysis did not affect patency. The median time from creation to first puncture was 73 days (IQR 51, 157) and 141 days (IQR 105, 225) for BB1 and BB2, respectively.
The two stage method had superior primary patency, counterbalanced by two operations. Long term patency was equivalent for the two surgical techniques. The incidence of endovascular re-interventions was high, and BBAVFs were less usable in females and patients with diabetes as a comorbidity.
肱动脉 - 贵要静脉动静脉内瘘（BBAVF）的建立可采用一期或二期手术；然而，关于最佳技术的证据存在矛盾。本全国性注册研究的目的是确定哪种方法的功能结局更佳。
这是一项回顾性观察研究，数据来自瑞典肾脏注册中心。纳入2011年至2019年期间年龄≥18岁患者所建立的BBAVF，并分为一期（BB1）或二期（BB2）。从建立之时起记录结局、通畅情况和并发症，以及所有开放和血管腔内重复手术。
BB1（n = 224）比BB2（n = 83）更常见。在BB2中，66例（80%）在第二阶段进行了转位。未进行转位的最常见原因是闭塞（n = 10）。中位随访时间为两年（四分位间距[IQR] 0.8，4.2）。总体而言，31%的BBAVF从未使用过。静脉狭窄很常见，在157例BB1（70%）和40例BB2（48%）中可见。每位患者每年血管腔内干预的发生率BB1是BB2的两倍（0.6对0.3）。BB1和BB2在1年时的初次通畅率分别为39%和54%（p = 0.002）。两组在1年和3年时的二次通畅率相似（BB1为81%和69%，BB2为82%和78%；p = 0.14）。糖尿病作为合并症和女性与较差的通畅情况相关，但体重指数≥30 kg/m²则不然。透析前建立内瘘不影响通畅情况。BB1和BB2从建立到首次穿刺的中位时间分别为73天（IQR 51，157）和141天（IQR 105，225）。
二期手术方法具有更好的初次通畅率，但需进行两次手术。两种手术技术的长期通畅率相当。血管腔内再次干预的发生率较高，BBAVF在女性和患有糖尿病合并症的患者中可用性较低。
