Comparison of forearm versus upper arm basilic transposition arteriovenous fistulas demonstrates equivalent satisfactory patency.
J Vasc Surg
; 70(4): 1247-1252, 2019 10.
Article
en En
| MEDLINE
| ID: mdl-31147119
ABSTRACT
OBJECTIVE:
In accordance with the Kidney Disease Outcomes Quality Initiative recommendations, attaining autogenous hemodialysis access, specifically via creation of radiocephalic arteriovenous fistulas (AVF), brachial-basilic (BB)-AVF, or brachial-cephalic AVFs, is preferred for mortality and morbidity benefits over catheter access in patients with end-stage renal disease. The aim of this study is to determine the suitability of forearm basilic vein transposition (FBVT) fistulas as an alternative access option by comparing outcomes with those of BB-AVFs.METHODS:
All patients who underwent creation of FBVT between 2007 and 2015 were identified retrospectively in the electronic medical record and compared with a sample of patients undergoing BB-AVF placement during this time. Access patency was examined using Kaplan-Meier methods and Cox proportional hazards regression.RESULTS:
We included 34 patients with FBVT (median age, 54 years; 67.6% male) and 49 with BB-AVF (median age, 57 years; 42.9% male) in this study. There were no significant differences in comorbid conditions between the two groups, with the exception of hyperlipidemia (29.4% FBVT vs 53.1% BB-AVF; P = .03). Although those with FBVT were more likely to have had previous permanent access attempts (70.6% vs 38.7%; P = .002), and access attempts on the same extremity (44.1% vs 24.4%; P = .04), there were no significant differences in primary patency (46.9% vs 53.3%; P = .6), primary-assisted patency (65.6% vs 73.3%; P = .5), or secondary patency (68.8% vs 82.2%; P = .2) at 1 year when compared with BB-AVF. The risk of loss of patency was not statistically different for FBVT as compared with BB-AVF (hazard ratio, 1.37; 95% confidence interval 0.65-2.88; P = .4). This risk did not vary for those who had previous access on the same arm (interaction P = .8). Four fistulas in each group failed to mature. Only one infectious complication was identified in the FBVT group.CONCLUSIONS:
No prior studies have directly compared outcomes of FBVTs with BB-AVFs at 1 year or longer. Despite the increased difficulty of harvesting the forearm basilic vein, particularly in patients who have had prior access attempts, there was no significant difference in patency between FBVTs and BB-AVFs. FBVTs are a reasonable option for hemodialysis access, particularly in patients without adequate cephalic veins or who previously failed radiocephalic fistula attempts.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_sistemas_informacao_saude
Asunto principal:
Brazo
/
Venas
/
Grado de Desobstrucción Vascular
/
Arteria Braquial
/
Derivación Arteriovenosa Quirúrgica
/
Diálisis Renal
/
Arteria Cubital
/
Arteria Radial
/
Antebrazo
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Vasc Surg
Asunto de la revista:
ANGIOLOGIA
Año:
2019
Tipo del documento:
Article