Long-Term Patency Between Brachiocephalic and Brachiobasilic Fistulas: A Single Institution Review.
AV fistula
Patency
brachiobasilic
brachiocephalic
dialysis
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
01 Jul 2024
01 Jul 2024
Historique:
received:
06
03
2024
revised:
07
06
2024
accepted:
07
06
2024
medline:
4
7
2024
pubmed:
4
7
2024
entrez:
3
7
2024
Statut:
aheadofprint
Résumé
Dialysis access is a fundamental procedure performed by vascular surgeons. Commonly, upper extremity access is utilized via a brachiobasilic fistula (BBF) or brachiocephalic fistula (BCF). BCF is preferred due to ease compared to BBF without documented improved function. Few studies compare patency outcomes between BBF and BCF over time. Our goal was to evaluate the difference in outcomes between BBF and BCF. This is a retrospective review of patients with BCF or BBF between 2019-2022. Patients were split by procedure: BCF and BBF. Data collected included demographics, vein size, tunneled catheter, and previous access. Primary outcomes included primary patency (PP), primary assisted patency (PAP) and secondary patency (SP). Secondary outcomes included 30-day complications, access abandonment, interventions and mortality. Linear regression, Kaplan-Meier and log-rank test were performed. Our study had 184 patients, 109 (59%) with BCF and 75 (41%) with BBF. There were no differences in demographics except for BMI and vein size (BBF: 4 vs BCF: 3.6mm, p=0.020). There was no difference in PP at one year (41% vs 47%, p=0.547) or SP at two years (73% vs 84%, p=0.058) in BBF vs BCF. However, PAP was significantly greater in BCF (80% vs 67%, p=0.030) at one year. Secondary outcomes revealed no difference in wound complications (1% vs 0%, p=0.408), access abandonment (35% vs 28%, p=0.260), or number of interventions (1 vs 1, p=0.712) in BBF vs BCF. Mortality was significantly greater in the BBF patients (19% vs 6%, p=0.005). On adjusted analysis, BBF had 43 minutes longer operative time (p<0.001) and 22cc greater blood loss (p<0.0001). In this single center review comparing BBF and BCF, no difference was seen between BBF and BCF in terms of primary patency or secondary patency. Even with larger vein size, BBF did not confer a benefit in long term patency or access abandonment. Additionally, BBF did not confer decreased procedures to maintain patency and BBF had greater operative length and blood loss, as well as mortality. We believe this study demonstrates that for patients who must use an upper extremity location, when the cephalic vein is satisfactory, using the cephalic vein is preferred as it does not negatively impact long-term patency.
Identifiants
pubmed: 38960096
pii: S0890-5096(24)00307-8
doi: 10.1016/j.avsg.2024.06.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.