- 作者：Fahad A. Syed ; Christopher J. Smolock ; Cassidy Duran ; Javier E. Anaya-Ayala ; Joseph J. Naoum ; Tam T. Hyunh ; Eric K. Peden ; Mark G. Davies ; mdavies@tmhs.org
- 刊名：Annals of Vascular Surgery
- 出版年：2012
- 出版时间：August, 2012
- 年：2012
- 卷：26
- 期：6
- 页码：852-857
- 全文大小：430 K
Background
Basilic vein transpositions (BVTs) provide autologous hemodialysis access in the upper extremity. We report and compare our experience using the two techniques that are commonly performed to create BVTs: the one-stage and the two-stage technique.Methods
A retrospective review was performed on patients who underwent BVT from June 2006 to June 2010 from a database of all patients undergoing dialysis access procedures. One hundred six patients, mean age of 54 years (41 % male), who received upper-arm basilic vein-only transposition were identified and were stratified based on one-stage and two-stage BVTs. Anatomic outcomes and functionality were determined and compared between stages.
Results
Seventy-seven patients underwent two-stage BVT, and 29 underwent one-stage BVT. Fifty-one percent and 79 % of the two-stage group and the one-stage group, respectively, had had a previous failed ipsilateral permanent access. Catheter dialysis at time of surgery was 14 % in one-stage BVT and 43 % in two-stage BVT. Immediate technical success was obtained in all cases. The rate of primary failure was 21 % in the one-stage group and 18 % in the two-stage group. Reintervention rates for the one-stage group and the two-stage group were 62 % and 66 % , respectively. Primary patency for the one-stage group and the two-stage group at 1 year was 82 % and 67 % , at 2 years was 81 % and 27 % , and at 3 years was 51 % and 18 % , respectively. Secondary patency for the one-stage group and the two-stage group at 1 year was 91 % and 81 % , at 2 years was 80 % and 61 % , and at 3 years was 58 % and 45 % , respectively. Thirty-day mortality was 0 % in both groups, and all-cause morbidity was 12 % in both groups (counting all stages).
Conclusion
One-stage BVTs have a similar number of initial failures and secondary interventions as two-stage BVTs. One-stage BVTs achieved better primary and cumulative patencies. There appears to be no advantage to a two-stage BVT in equally matched patients.