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Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
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Randomized controlled trial comparing primary and staged basilic vein transposition.

Stavros K Kakkos1, Ioannis A Tsolakis1, Spyros I Papadoulas1

  • 1Department of Vascular Surgery, University Hospital of Patras , Patras , Greece.

Frontiers in Surgery
|May 15, 2015
PubMed
Summary

For patients needing a transposed brachio-basilic vein (TBBV) fistula with small basilic veins, a staged procedure significantly improves fistula maturation rates compared to a primary approach, suggesting better long-term outcomes.

Keywords:
arteriovenous recommend that fistulabasilic veinmaturationpatencytransposition

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Dialysis Access

Background:

  • The optimal surgical approach for creating a transposed brachio-basilic vein (TBBV) fistula, particularly in patients with smaller basilic veins, remains debated.
  • This study addresses the clinical question of whether a primary or staged procedure yields superior outcomes for TBBV fistula creation.

Purpose of the Study:

  • To compare the efficacy of primary versus staged TBBV fistula creation in patients with basilic veins measuring at least 2.5 mm.
  • To evaluate key fistula maturation and patency rates between the two surgical techniques.

Main Methods:

  • A randomized controlled trial involving 16 patients with suitable basilic veins (≥2.5 mm).
  • Patients were randomized to either a primary TBBV fistula (n=9) or a staged TBBV fistula (n=7), involving initial fistula creation followed by transposition weeks later.
  • Primary outcomes included fistula maturation at 10 weeks, and primary, assisted-primary, and secondary patency rates.

Main Results:

  • The staged TBBV fistula group demonstrated significantly higher maturation rates (100%) compared to the primary group (33%, P=0.011).
  • While time to hemodialysis was not significantly different, there was a trend towards improved 1-year secondary patency in the staged group (86% vs. 44%).
  • The trial was terminated early due to the significant difference in maturation rates.

Conclusions:

  • Staged transposition for TBBV fistula creation in patients with small basilic veins leads to superior maturation rates compared to primary procedures.
  • This improved initial maturation in the staged approach may translate to better long-term secondary patency, making it a preferred method in this patient population.