目的:透析是血管外科医师进行的基本手术。通常,上肢通路是通过肱动脉瘘(BBF)或头臂瘘(BCF)。BCF是优选的,因为与没有记录的改善功能的BBF相比容易。很少有研究比较BBF和BCF随时间的通畅性结果。我们的目标是评估BBF和BCF之间结果的差异。
方法:这是2019-2022年间BCF或BBF患者的回顾性研究。通过程序将患者分开:BCF和BBF。收集的数据包括人口统计,静脉大小,隧道式导管,和以前的访问。主要结果包括原发性通畅性(PP),初级辅助通畅(PAP)和次级通畅(SP)。次要结果包括30天并发症,放弃访问,干预和死亡率。线性回归,进行Kaplan-Meier和对数秩检验。
结果:我们的研究有184名患者,109(59%)与BCF和75(41%)与BBF。除了BMI和静脉大小(BBF:4vsBCF:3.6mm,p=0.020)。一年的PP没有差异(41%对47%,p=0.547)或两年时的SP(73%对84%,p=0.058)在BBF与BCF中。然而,BCF中的PAP明显更高(80%vs67%,p=0.030)在一年。次要结果显示伤口并发症无差异(1%vs0%,p=0.408),放弃访问(35%对28%,p=0.260),或BBF与BCF的干预次数(1vs1,p=0.712)。BBF患者的死亡率明显更高(19%vs6%,p=0.005)。在调整后的分析中,BBF的手术时间延长了43分钟(p<0.001),失血量增加了22cc(p<0.0001)。
结论:在这项比较BBF和BCF的单中心综述中,BBF和BCF在原发性通畅性或继发性通畅性方面无差异.即使静脉尺寸更大,BBF在长期开放或放弃访问方面没有任何好处。此外,BBF不能减少维持通畅的手术,并且BBF的手术长度和失血更多。以及死亡率。我们相信这项研究表明,对于必须使用上肢位置的患者,当头静脉令人满意时,优选使用头静脉,因为它不会对长期通畅产生负面影响.
BACKGROUND: Dialysis access is a fundamental procedure performed by vascular surgeons. Commonly, upper extremity access is utilized via a brachiobasilic fistula (BBF) or brachiocephalic fistula (BCF). BCF is preferred due to ease compared to BBF without documented improved function. Few studies compare
patency outcomes between BBF and BCF over time. Our goal was to evaluate the difference in outcomes between BBF and BCF.
METHODS: This is a retrospective review of patients with BCF or BBF between 2019 and 2022. Patients were split by procedure: BCF and BBF. Data collected included demographics, vein size, tunneled catheter, and previous access. Primary outcomes included primary
patency (PP), primary assisted
patency (PAP) and secondary
patency (SP). Secondary outcomes included 30-day complications, access abandonment, interventions and mortality. Linear regression, Kaplan-Meier, and log-rank test were performed.
RESULTS: Our study had 184 patients, 109 (59%) with BCF and 75 (41%) with BBF. There were no differences in demographics except for body mass index and vein size (BBF: 4 vs. BCF: 3.6 mm, P = 0.020). There was no difference in PP at 1 year (41% vs. 47%, P = 0.547) or SP at 2 years (73% vs. 84%, P = 0.058) in BBF versus BCF. However, PAP was significantly greater in BCF (80% vs. 67%, P = 0.030) at 1 year. Secondary outcomes revealed no difference in wound complications (1% vs. 0%, P = 0.408), access abandonment (35% vs. 28%, P = 0.260), or number of interventions (1 vs. 1, P = 0.712) in BBF versus BCF. Mortality was significantly greater in the BBF patients (19% vs. 6%, P = 0.005). On adjusted analysis, BBF had 43 min longer operative time (P < 0.001) and 22 cc greater blood loss (P < 0.0001).
CONCLUSIONS: In this single center review comparing BBF and BCF, no difference was seen between BBF and BCF in terms of PP or SP. Even with larger vein size, BBF did not confer a benefit in long term
patency or access abandonment. Additionally, BBF did not confer decreased procedures to maintain
patency and BBF had greater operative length and blood loss, as well as mortality. We believe this study demonstrates that for patients who must use an upper extremity location, when the cephalic vein is satisfactory, using the cephalic vein is preferred as it does not negatively impact long-term
patency.