TITLE: Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis.

BACKGROUND:Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis.

METHODS:A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions.

RESULTS:Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001).

CONCLUSION:Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.

SOURCE: Cheng CT, Chang YC, Tam KW, Yen YC, Ko YC. Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis. Vasc Endovascular Surg. 2021. 55(2): 164-170.

背景：对于长期的血液透析患者而言，建立和维持正常的动静脉通路是至关重要的。当桡-头内瘘或肱-头内瘘无法建立或失败时，可以选择肱-贵要内瘘转位（BBF）或动静脉移植物（AVG）。这项研究比较了血液透析患者中​​BBF和AVG之间的通畅性和并发症。

方法：回顾性研究于2015年11月至2020年5月在台湾双河医院进行。所有手术均由一名外科医生完成。主要结局为BBF和AVG组的一期通畅率，一期辅助通畅率和二期通畅率。次要结果是并发症和再次干预的发生率。

结果：连续144例患者中，分别有20例和124例进行了BBF和AVG的产生。中位随访时间为19.2个月。 BBF组在1年和2年时的一期通畅率为67％和19％，AVG组为44％和16％（P = 0.126）。 BBF组在1年和2年时的一期辅助通畅率为82％和54％，AVG组为54％和30％（P = 0.012）。 BBF组在1年和2年时的二期通畅率分别为100％和82％，AVG组分别为81％和67％（P = 0.078）。 AVG的并发症发生率明显高于BBF组（每患者年1.7与0.93，P <0.001）。

结论：与AVG组相比，BBF组的一期辅助通畅性更好，并发症和干预率更低。因此，如果可以使用贵要静脉重建术，那么对于头静脉衰竭的患者，BBF是一种可靠的选择。

启发：贵要静脉重建不仅可以提供可行的穿刺段血管，还有较头静脉更好的静脉回路，是一种不错选择。