Brachiobasilic fistula formation - single versus two stage procedure
B F Robertson1, G A Robertson, L Khan
1Royal Infirmary, Edinburgh, United Kingdom.
Summary
Comparing single-stage and two-stage brachial basilic (BB) fistulae for dialysis vascular access, this study found no significant difference in patency. However, creating fistulae before starting dialysis improved long-term outcomes.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Brachial basilic (BB) fistulae serve as critical vascular access for dialysis patients when cephalic vein options are unsuitable.
- BB fistulae can be created using either a single-stage or a two-stage surgical approach.
Purpose of the Study:
- To compare the efficacy and outcomes of single-stage versus two-stage BB fistula creation techniques.
- To evaluate factors influencing fistula patency and survival.
Main Methods:
- A retrospective analysis of 73 BB fistulae (29 single-stage, 44 two-stage) created between 2003 and 2008.
- Prospective data collection on fistula patency and time to maturity, alongside demographic and clinical data from patient records.
Main Results:
- No statistically significant difference in functional patency rates was observed between the single-stage and two-stage BB fistula groups.
- Fistulae created prior to the initiation of dialysis demonstrated significantly higher initial patency rates (p=0.017) and long-term survival (p=0.002) compared to those created after dialysis commencement.
Conclusions:
- The choice between single-stage and two-stage BB fistula creation does not significantly impact patency rates.
- A single-stage procedure may offer advantages by providing quicker vascular access.
- Pre-dialysis creation of BB fistulae is associated with improved patency and survival, highlighting the importance of timely surgical planning.