Comparative study between one stage and two-stages superficialization of brachio-basilic arteriovenous fistula as a hemodialysis access procedure

Document Type : Original Article

Authors

1 Department of Vascular Surgery Faculty of Medicine, Helwan University, Egypt

2 Department of General Surgery Faculty of Medicine, Helwan University, Egypt

Abstract

Background: The best technique for creating brachiobasilic arteriovenous fistulas (BBAVFs) is still up for debate.
Because of this, the purpose of this study was to examine the patencies, primary failure rates, and complication rates of
brachiaobasilic arteriovenous fistulas formed using the one-stage and two-stage superficialization techniques.
Patients and Methods: In order to compare one stage and two-stage superficialization of brachiobasilic arteriovenous
fistula, a prospective, randomized controlled clinical trial including 38 patients undergoing brachiobasilic arteriovenous
fistula operations for end-stage renal disease was carried out. Two groups of patients were created using basic randomization.
Patients in Group I underwent a single step of superficialization for their brachiobasilic arteriovenous fistula, whereas
patients in Group II got a two-stage superficialization procedure.
Results: Patients with two-stage BBAVF had a substantially longer fistula maturation period than patients with onestage BBAVF. However, patients with two-stage BBAVF also had considerably greater fistula flow rate and primary
functional patency when compared to patients with one-stage BBAVF. In terms of the complications in both groups,
patients with one-stage BBAVF had a considerably greater incidence of thrombosis and post-operative hematoma than
patients with two-stage BBAVF. However, there was no discermible difference in the two groups’ incidence of infection,
steal syndrome, hematoma, or pseudoaneurysm.
Conclusion: An arteriovenous fistula (AVF) formation with BBAVF could be considered an attractive approach as it can
help to reduce the risk of complications such as failure to mature, infection, distal ischemia, and venous edema. While
two-stage BBAVF may have the drawback of delayed fistula use, it has been shown to be more effective than one-stage
BBAVF in terms of minimizing postoperative complications.

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