One-stage versus two-stage brachiobasilic arteriovenous fistula with superficialization of the basilic vein regarding patency and failure rates

Background
Safe, reliable, and durable vascular access is essential for successful hemodialysis. Native arteriovenous fistulae have the best long-term patency rates compared with other methods, for example, synthetic grafts and double-lumen catheters. Autogenous arteriovenous fistulae also have the lowest cost and lowest infection rate. If the patient does not have a suitable cephalic vein at the wrist for a Brescia–Cimino–Appel native arteriovenous fistula or at the upper arm for a brachiocephalic arteriovenous fistula, brachiobasilic arteriovenous fistulas (BBAVF) transposition is considered. Currently, there are two usual methods of BBAVF creation: a one-stage or a two-stage operation.
Objectives
The aim of this study is to compare between one-stage and the two-stage techniques in the formation of BBAVF regarding primary patency, secondary patency, and failure rates.
Patients and methods
A total of 56 patients with end-stage renal disease were enrolled in the study. The study is a prospective randomized interventional analytical clinical trial conducted in El-Sahel Teaching and Ain Shams hospitals. All patients were evaluated for full history, upper extremity examination, and measurements of basilic vein and brachial artery diameters using duplex. A total of 56 patients were included from the Vascular Surgery Department of Ain Shams University and El-Sahel Teaching hospitals (and other authorized hospitals under the supervision of thesis supervisors).
Results
On following up the patients over a period of 6 months, there was a primary patency rate of 82.1% for all of the patients who underwent one-stage BBAVF, compared with a 96.4% primary patency rate for those who underwent two-stage BBAVF. There was no statistically significant difference between both groups regarding the primary patency rate over a period of 6 months (=0.084). There was a 92.9% secondary patency rate for all of the cases in both groups (=1.000). None of the cases were considered to have primary failure.
Conclusion
There was no statistically significant difference between one-stage and two-stage techniques of BBAVF creation, with comparable complication rates between both groups.