Comparison of one-stage and two-stage upper arm brachiobasilic arteriovenous fistula in the Vascular Quality Initiative

Tze Woei Tan, Jeffrey J. Siracuse, Benjamin S. Brooke, Donald T. Baril, Karen Woo, Denis Rybin, Gheorghe Doros, Alik Farber

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objective: An upper arm brachiobasilic arteriovenous fistula (BBAVF) is a reliable autogenous hemodialysis access created with a one-stage or two-stage technique. Although both techniques are variably used, the optimal approach is uncertain. In this study, we compared the outcomes of one-stage and two-stage BBAVF procedures. Methods: We identified 2648 patients who had received BBAVFs within the Vascular Quality Initiative data set (2010-2016) and compared those created using the one-stage and two-stage technique. The primary outcome measures were primary and secondary patency rates at 12 months. Other outcomes assessed were wound infection, steal, and swelling at 3 months. The log-rank test was used to evaluate patency by Kaplan-Meier analysis. Cox proportional hazards models were used to examine the adjusted association between surgical technique and outcomes. Results: There were 1234 (47%) one-stage and 1414 (53%) two-stage BBAVFs in the study cohort, including 1848 (70%) patients who were on dialysis at the time of surgery and 1795 (68%) patients with a history of previous access. Patients who underwent a one-stage BBAVF were more likely to be male (54% vs 45%; P <.001), to be white (60% vs 41%; P <.001), and to have a history of coronary artery disease (22% vs 17%; P =.001). Patients undergoing one-stage BBAVFs have larger vein diameters (4.1 vs 3.4 mm; P <.001) and have the procedure in an inpatient setting (21% vs 13%; P <.001) compared with patients undergoing a two-stage procedure. The 12-month primary patency rate was higher for the one-stage BBAVF (49.1% vs 40.4%; P =.005), although the secondary patency rate was comparable (80.0% vs 77.9%; P =.54). Postoperative bleeding (4% vs 1.5%; P <.001), wound infection (1.01% vs 0.4%; P =.047), and arm swelling (2.1 % vs 0.8%; P =.006) were higher for one-stage BBAVFs. In multivariable analysis, although loss of primary patency at 12 months (adjusted hazard ratio [aHR], 1.12; 95% confidence interval [CI], 0.97-1.30; P =.12) and 3-month wound infection (aHR, 0.42; 95% CI, 0.14-1.25, P =.12) were similar between the two approaches, the risk of 3-month arm swelling was significantly lower for two-stage BBAVFs (aHR, 0.35; 95% CI, 0.16-0.77; P =.009). Conclusions: Whereas surgeons were more likely to perform a two-stage BBAVF in patients with a history of previously failed access and smaller basilic vein, our data show no difference in primary or secondary patency of one-stage and two-stage BBAVFs at 12 months.

Original languageEnglish (US)
Pages (from-to)1187-1195.e2
JournalJournal of vascular surgery
Volume69
Issue number4
DOIs
StatePublished - Apr 2019
Externally publishedYes

Keywords

  • Autologous hemodialysis access
  • Brachial-basilic arteriovenous fistula
  • Brachiobasilic transposition fistula
  • One-stage or two-stage brachial-basilic fistula

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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