Abstract：
OBJECTIVE: After forearm and arm cephalic veins are no longer available as options, the choices of arm vascular access between one-staged brachial-basilic vein transposition (BBAVF) and arm straight arteriovenous graft (AS-AVG) for hemodialysis are controversial. This study aims to compare outcomes between groups.
METHODS: All one-staged BBAVF and AS-AVG from August 2014 to December 2019 were reviewed. In cases of suitable basilic vein of 3 mm or more present from cubital crease to axilla, one-staged BBAVF was preferred. AS-AVG was performed for patients who need timely functioning access or have no suitable basilic vein.
RESULTS: Twenty-eight one-staged BBAVF and 74 AS-AVG were included. Baseline characteristics were not significantly different, except AS-AVG had less previous ipsilateral access (9% vs 39%; p < .001). Postoperative complications were not different. With six loss follow-ups (3 in BBAVF and 3 in AS-AVG), 24 (96%) and 64 (90%) matured after one-staged BBAVF and AS-AVG, respectively (p = .676). BBAVF took about 30 days (95% CI: 10, 51) longer time to first successful cannulation. Primary patency was significantly better for one-staged BBAVF (hazard ratio (HR) of 3.0 (95%CI: 1.2, 7.7)), whereas secondary patency was not different. The total access failure (i.e. failure to mature combined with any thrombosis or intervention to maintain patency) significantly favored BBAVF (HR 2.7 (95%CI: 1.1, 6.6)).
CONCLUSIONS: Provided a suitable arm basilic vein is available, one-staged BBAVF is preferred over AS-AVG when forearm AVF, forearm AVG, and arm cephalic veins are out. However, it requires a longer time to start cannulating than AS-AVG.
METHODS: All one-staged BBAVF and AS-AVG from August 2014 to December 2019 were reviewed. In cases of suitable basilic vein of 3 mm or more present from cubital crease to axilla, one-staged BBAVF was preferred. AS-AVG was performed for patients who need timely functioning access or have no suitable basilic vein.
RESULTS: Twenty-eight one-staged BBAVF and 74 AS-AVG were included. Baseline characteristics were not significantly different, except AS-AVG had less previous ipsilateral access (9% vs 39%; p < .001). Postoperative complications were not different. With six loss follow-ups (3 in BBAVF and 3 in AS-AVG), 24 (96%) and 64 (90%) matured after one-staged BBAVF and AS-AVG, respectively (p = .676). BBAVF took about 30 days (95% CI: 10, 51) longer time to first successful cannulation. Primary patency was significantly better for one-staged BBAVF (hazard ratio (HR) of 3.0 (95%CI: 1.2, 7.7)), whereas secondary patency was not different. The total access failure (i.e. failure to mature combined with any thrombosis or intervention to maintain patency) significantly favored BBAVF (HR 2.7 (95%CI: 1.1, 6.6)).
CONCLUSIONS: Provided a suitable arm basilic vein is available, one-staged BBAVF is preferred over AS-AVG when forearm AVF, forearm AVG, and arm cephalic veins are out. However, it requires a longer time to start cannulating than AS-AVG.
摘要：
目标：在前臂和臂头静脉不再作为选项后，对于血液透析患者,在一期贵重臂-基底静脉转位(BBAVF)和直臂动静脉移植(AS-AVG)之间选择上臂血管通路存在争议.本研究旨在比较各组之间的结果。
方法：回顾了2014年8月至2019年12月的所有一期BBAVF和AS-AVG。如果从肘部折痕到腋窝存在3毫米或更大的合适的贵重静脉，一级BBAVF是首选。AS-AVG适用于需要及时有效通路或没有合适贵重静脉的患者。
结果：包括28个一期BBAVF和74个AS-AVG。基线特征无显著差异,除了AS-AVG之前的同侧通路较少(9%vs39%；p<.001)。术后并发症无差异。有6次损失随访(BBAVF3次，AS-AVG3次)，24（96%）和64（90%）在一级BBAVF和AS-AVG后成熟，分别（p=.676）。BBAVF花费了约30天(95%CI:10,51)的更长时间来首次成功插管。一级BBAVF的主要通畅性显着更好（危险比（HR）为3.0（95CI：1.2，7.7）），而继发性通畅性没有差异。总的通路失败(即未能成熟结合任何血栓形成或维持通畅的干预)显著有利于BBAVF(HR2.7(95CI:1.1,6.6))。
结论：只要有合适的手臂贵重静脉，当前臂AVF时，一级BBAVF优于AS-AVG，前臂AVG,手臂头静脉都出来了.然而,它需要比AS-AVG更长的时间来开始插管。
方法：回顾了2014年8月至2019年12月的所有一期BBAVF和AS-AVG。如果从肘部折痕到腋窝存在3毫米或更大的合适的贵重静脉，一级BBAVF是首选。AS-AVG适用于需要及时有效通路或没有合适贵重静脉的患者。
结果：包括28个一期BBAVF和74个AS-AVG。基线特征无显著差异,除了AS-AVG之前的同侧通路较少(9%vs39%；p<.001)。术后并发症无差异。有6次损失随访(BBAVF3次，AS-AVG3次)，24（96%）和64（90%）在一级BBAVF和AS-AVG后成熟，分别（p=.676）。BBAVF花费了约30天(95%CI:10,51)的更长时间来首次成功插管。一级BBAVF的主要通畅性显着更好（危险比（HR）为3.0（95CI：1.2，7.7）），而继发性通畅性没有差异。总的通路失败(即未能成熟结合任何血栓形成或维持通畅的干预)显著有利于BBAVF(HR2.7(95CI:1.1,6.6))。
结论：只要有合适的手臂贵重静脉，当前臂AVF时，一级BBAVF优于AS-AVG，前臂AVG,手臂头静脉都出来了.然而,它需要比AS-AVG更长的时间来开始插管。
