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Basilic vein transposition: what is the optimal technique?
S K Kakkos1, G K Haddad, M R Weaver
1Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, K-8, 2799 W Grand Boulevard, Detroit, MI 48202, USA.
Summary
The two-stage basilic vein transposition (BVT) fistula technique shows lower complication rates than the one-stage method. However, the one-stage BVT fistula allows for faster access use, though maturation rates are similar.
Area of Science:
- Vascular Surgery
- Dialysis Access
- Surgical Techniques
Background:
- Basilic vein transposition (BVT) fistula is a common procedure for hemodialysis access.
- Optimizing BVT fistula techniques is crucial for patient outcomes and access longevity.
Purpose of the Study:
- To compare the morbidity and maturation rates of a one-stage BVT fistula with a modified two-stage technique.
- To evaluate the efficacy and safety of different BVT fistula surgical approaches.
Main Methods:
- Retrospective case-controlled study involving 173 patients undergoing BVT fistula creation.
- Comparison of one-stage BVT (single incision) versus two-stage BVT (two skip incisions) procedures.
- Outcome measures included morbidity (venous hypertension, hematomas, complications) and fistula maturation rates.
Main Results:
- The two-stage BVT technique demonstrated significantly lower rates of venous hypertension (4% vs. 17%), wound hematomas (3% vs. 13%), and overall complications (11% vs. 43%) compared to the one-stage approach.
- Time to fistula use was significantly shorter for the one-stage BVT (68 days) versus the two-stage BVT (132 days).
- Failure to mature rates were comparable between the two techniques (15% vs. 18%).
Conclusions:
- The two-stage BVT fistula technique is associated with reduced morbidity compared to the one-stage procedure.
- The one-stage BVT fistula offers faster access to use but with higher complication risks.
- An individualized approach is recommended, and further research is needed to definitively establish the superiority of either technique.
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