Assessment of patency for the second-stage brachiobasilic arteriovenous fistula: A comparative study between basilic vein transpositioning and superficialization | ||
| The Egyptian Journal of Surgery | ||
| Article 67, Volume 41, Issue 3, July 2022 PDF (1.98 M) | ||
| DOI: 10.4103/ejs.ejs_215_22 | ||
| Authors | ||
| Mohamed A. Helal; Sherif M. Essam; Mohamed M. Ismail; Karim S. Gohar | ||
| Abstract | ||
| Background Arteriovenous fistula (AVF) is the most frequently used method for hemodialysis in patients with end-stage renal disease. The National Kidney Foundation Dialysis Outcome Quality Initiative recommends autologous radiocephalic or brachiocephalic AVF as a primary method of choice in hemodialysis patients, but for the patients with failed radiocephalic fistula or brachiocephalic fistula or with smaller caliber superficial veins, vascular access becomes difficult. Therefore, the basilic vein AVF as a secondary option is recommended in those patients. Aim To compare outcomes for both techniques in the creation of brachiobasilic AVF, namely, in the second-stage basilic vein transposition or the second-stage basilic vein superficialization, as well as to determine the primary, assisted primary, and secondary patency of each technique throughout 18 months of follow-up and to detect any procedure-related complications. Patients and methods This is a prospective nonrandomized closed envelope clinical trial. This study was conducted at Ain Shams University Hospitals on 50 patients with end-stage renal disease on regular dialysis subjected to brachiobasilic AVF in the period from March 2020 to November 2020. Follow-up was done for 18 months till May 2022. The patients were divided into two groups according to the type of access procedure as the basilic vein superficialization (BBAVFS) group (=25) and basilic vein transposition (BBAVFTn) group (=25). The primary, assisted primary, and secondary patency rates were evaluated. Results During the follow-up, the mean age of the cases in group A was 53.56 years and in group B was 57.16 years, with no statistically significant difference between both groups regarding demographic data. In group A, the primary patency rates at 3, 6, 12, and 18 months were 92, 84, 64, and 56%, respectively; the assisted primary patency rates at 3, 6, 12, and 18 months were 100, 96, 80, and 72%, respectively; and the secondary patency rates at 3, 6, 12, and 18 months were 100, 96, 88, and 80%, respectively. However, in group B, the primary patency rates at 3, 6, 12, and 18 months were 88, 72, 52, and 40%, respectively; the assisted primary patency rates at 3, 6, 12, and 18 months were 96, 88, 64, and 52%, respectively; and the secondary patency rates at 3, 6, 12, and 18 months were 96, 96, 84, and 68%, respectively. There was only one case with hematoma detected in the BBAVFT group. There was no statistically significant difference in the patency rates or postoperative complications between the groups. Conclusion Owing to their low complication and high patency rates, both basilic vein superficialization and basilic vein transposition can be safely employed in patients in whom AVF cannot be established with the cephalic vein. | ||
| Keywords | ||
| Arteriovenous fistula; basilic vein transposition; chronic renal insufficiency; Hemodialysis; superficialization | ||
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