European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2009
Autogenous brachial-brachial fistula for vein access. Haemodynamic factors predicting outcome and 1 year clinical data.
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Lioupis C, Mistry H, Chandak P, Tyrrell M, Valenti D
Аннотация
UNLABELLED: Two-stage autogenous brachial vein-brachial artery access (ABBA) has been proposed as an option where adequate superficial vein is not available for the creation of conventional haemodialysis fistulae.
METHODS: This report depicts the clinical outcome of a series of 17 consecutive patients who underwent ABBA in a single centre. Of the 17 patients, nine had had at least one previous arterioventricular (AV) fistula or graft, and eight were new to haemodialysis. Patencies were assessed using the Kaplan-Meier survival analysis.
RESULTS: In 14 patients, the brachial vein was transposed (82%) and the time to transposition ranged from 4 to 26 weeks (median time: 6 weeks). The functional patency rate was 45.75% at 12 months. After stage one, all fistulas that went on to develop well had a brachial vein flow of at least 900 ml min(-1), and this was significantly higher than in fistulas that failed to develop (p=0.005). The maturation rate in our study was 65% and the median time to cannulation of the fistula was 8 weeks from the stage 1. Of the 17 patients, 12 (71%) experienced at least one complication. Ten (59%) demonstrated moderate-to-severe stenoses; eight of which necessitated angioplasty and/or percutaneous mechanical thrombolysis.
CONCLUSIONS: ABBA was characterised by a high incidence of complications and a long period to achieve maturation. Despite close monitoring and a high rate of secondary interventions, the patency rate was low. With this experience, we now only consider it an alternative in patients without adequate superficial veins, who have had failed grafts or where there is a very high risk of infection.
METHODS: This report depicts the clinical outcome of a series of 17 consecutive patients who underwent ABBA in a single centre. Of the 17 patients, nine had had at least one previous arterioventricular (AV) fistula or graft, and eight were new to haemodialysis. Patencies were assessed using the Kaplan-Meier survival analysis.
RESULTS: In 14 patients, the brachial vein was transposed (82%) and the time to transposition ranged from 4 to 26 weeks (median time: 6 weeks). The functional patency rate was 45.75% at 12 months. After stage one, all fistulas that went on to develop well had a brachial vein flow of at least 900 ml min(-1), and this was significantly higher than in fistulas that failed to develop (p=0.005). The maturation rate in our study was 65% and the median time to cannulation of the fistula was 8 weeks from the stage 1. Of the 17 patients, 12 (71%) experienced at least one complication. Ten (59%) demonstrated moderate-to-severe stenoses; eight of which necessitated angioplasty and/or percutaneous mechanical thrombolysis.
CONCLUSIONS: ABBA was characterised by a high incidence of complications and a long period to achieve maturation. Despite close monitoring and a high rate of secondary interventions, the patency rate was low. With this experience, we now only consider it an alternative in patients without adequate superficial veins, who have had failed grafts or where there is a very high risk of infection.