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Outcomes of Single‐Stage Compared to Two‐Stage Basilic Vein Transposition Fistulae
Author(s) -
Agarwal Amol,
Mantell Mark,
Cohen Raphael,
Yan Yan,
Trerotola Scott,
Clark Timothy W
Publication year - 2013
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12170
Subject(s) - basilic vein , medicine , stage (stratigraphy) , percutaneous , fistula , surgery , transposition (logic) , prospective cohort study , cohort , biology , paleontology , linguistics , philosophy
Basilic vein transposition ( BVT ) fistulae are increasing in prevalence in the United States. We examined outcomes of BVT fistulae created in a single stage compared to those created in two stages. Prospective QA databases identified a consecutive cohort of 144 patients with BVT fistulae. Of these, 42% were created in one stage and 58% in two stages. Fistula maturation rates, mean time to fistula use and intensity of percutaneous interventions were compared; patency rates were compared from time of first intervention. Maturation rates (including assisted maturation) were 90% among 1‐stage and 75% among 2‐stage BVT ( p = 0.02). Mean time to initiation of fistula use was 142 days (1‐stage) and 146 days (2‐stage) ( p = 0.92). Intensity of percutaneous interventions was 1.84/patient‐year of dialysis ( PYD ) (1‐stage) and 2.15/ PYD (2‐stage) ( p = 0.57). Secondary patency at 1, 2, 3, and 4 years for 1‐stage BVT was 86%, 75%, 69%, and 57%; secondary patency at 1, 2, 3, and 4 years for 2‐stage BVT was 76%, 71%, 49%, and 25%, respectively ( p = 0.12). BVT creation in two stages confers only a modest reduction in maturation rates and secondary patency and therefore should be considered over a synthetic graft in patients with basilic veins deemed inadequate for 1‐stage BVT .