CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
367
disease. The incidence of corrective surgery due to steal syndrome
was up to 6.5% in the literature.
22,24,25
Our results for surgery due to
steal syndrome were consistent with that in the literature.
In our study, the rate of fistula maturation was 66% in group 1
and 77% in group 2, indicating a higher rate in group 2, whereas
the rate of thrombosis was 34% in group 1 and 23% in group
2, indicating a higher rate in group 1 (
p
<
0.05). Review of the
literature revealed that the rate of fistula maturation following
BVT was 62–97%.
24,26-29
In our study, the mean diameter of the operated basilic vein
was significantly higher in group 1 (3.46
±
0.2 mm) than in
group 2 (2.79
±
0.1 mm) (
p
<
0.05). However, the rate of fistula
maturation was higher in group 2, suggesting that the basilic vein
that was arterialised using two-stage BVT may have adopted
the changes seen in the venous configuration, although this is a
controversial issue in the literature.
The rate of patency at 36 months reported by Cantelmo
et al
.
30
was 57%, while it was 52% at 30 months as reported by Rivers
et al
.
19
In the literature, the rate of thrombosis was 3–38% with
a wide range.
23,24,26-29
There are few studies in the literature comparing different
techniques for BVT.
5,8,31
Kakkos
et al
.
31
compared one-stage and
modified two-stage BVT and found that fistula maturation was
85.5% in group 1 and 81.6% in group 2. The authors concluded
that there was no significant difference between the groups. In our
study, the rate of fistula maturation was higher in group 2 than in
group 1, although the mean diameter of the basilic vein was larger
in group 1. This is the most important aspect of our study.
The mean diameter of the basilic vein that underwent BVT
was not predetermined and it is well known that many factors
influence fistula maturation.
1,24,26,28,29,32,33
In addition, the most
important limitation of our study compared to that of Kakkos
et
al.
31
was the non-randomised design.
With the study limitations, we discuss the possible effects of
two complications, haemorrhage and haematoma, on thrombosis
and fistula maturation. In our study, a significant difference
was observed in terms of haemorrhage (36% in group 1; 17%
in group 2) and haematoma (14% in group 1; 6% in group
2) between the groups (
p
<
0.05). Considering an equivalent
heparin dose was administered to both groups, the higher rate
of haemorrhage and haematoma may have resulted from wider
surgical incisions in group 1. However, randomised clinical
studies are required to draw a firm conclusion.
Review of the literature revealed that the rate of haematoma
was 3.6–11% in other studies.
10,11,34
In our study, we found the
rate of haematoma to be higher in group 1(17%) than in group 2
(8%). The rate of haematoma in group 2 was therefore consistent
with the literature.
With regard to possible factors affecting fistula maturation
following BVT, postoperative haematoma and venous
hypertension may be more important than the diameter of the
basilic vein. This finding is also consistent with data published
in the literature.
21-23,24,25,31
With regard to auxiliary interventions, the rate of intervention
for early (
≤
10 days) fistula thrombosis was significantly
higher in group 1 (21%) than in group 2 (12%). The number
of surgeries due to haemorrhage and haematoma was 17 and
10%, respectively in group 1, and 6 and 2%, respectively in
group 2 (
p
<
0.05). These findings support the assumption that
haemorrhage and haematoma are the most important factors in
fistula maturation and thrombosis. There was no statistically
significant difference in auxiliary interventions due to late (
≥
10
days) fistula thrombosis (20, 22%), pseudo-aneurysm (4, 6%)
and steal syndrome (4, 6%) between the groups.
Conclusion
AVF formation using BVT is a compelling procedure for the
surgeon in order to avoid possible complications, including loss
of function, infection, distal ischaemia and venous oedema.
Two-stage BVT is superior to one-stage BVT due to its lower
rate of postoperative complications, despite the disadvantage of
late fistula use. Although the diameter of the basilic vein was
higher in our patients who underwent one-stage BVT, we found
one-stage BVT was disadvantageous in terms of postoperative
complications and fistula maturation. However, we believe the
method to be applied should be individually designed until
further studies can be performed to establish the superiority of
either of these techniques.
References
1.
Quinton WE, Dillard D, Scribner BH. Cannulation of blood vessels for
prolonged hemodialysis.
Tr Am Soc Artif Int Organs
1960;
6
: 104–113.
2.
Foundation NK. KDOQI clinical practice guidelines and clinical
practice recommendations for 2006 updates: hemodialysis adequacy,
peritoneal dialysis adequacy and vascular access.
Am J Kidney Dis
2006;
48
(Suppl 1): 1–322.
3.
Foundation NK. KDOQI clinical practice guidelines for vascular
access, 2000.
Am J Kidney Dis
2001;
37
(Suppl 1): 137–181.
4.
Dagher FJ, Gelber RL, Ramos EJ, Sadler JH. Basilic vein to brachial
artery fistula: a new access for chronic hemodialysis.
Sthn Med J
1976;
69
: 1438–1440.
5.
El Mallah S. Staged basilic vein transposition for dialysis angioaccess.
Int Angiol
1998;
17
: 65–68.
6.
Zielinski CM, Mittal SK, Anderson P, Cummings J, Fenton S, Reiland-
Smith J,
et al
. Delayed superficialization of brachiobasilic fistula: tech-
nique and initial experience.
Arch Surg
2001;
136
: 929–932.
7.
Kapala A, Szmytkowski J, Stankiewicz W, Dabrowiecki S. A modified
technique of delayed basilic transposition – initial results.
Eur J Vasc
Endovasc Surg
2006;
32
: 316–317.
8.
Hossny A. Brachiobasilic arteriovenous fistula: different surgical tech-
niques and their effects on fistula patency and dialysis related complica-
tions.
J Vasc Surg
2003;
37
: 821–826.
9.
Hill BB, Chan AK, Faruqi RM, Arko FR, Zarins CK, Fogarty TJ.
Keyhole technique for autologous brachiobasilic transposition arterio-
venous fistula.
J Vasc Surg
2005;
42
: 945–50.
10. Martinez BD, LeSar CJ, Fogarty TJ, Zarins CK, Hermann G.
Transposition of the basilic vein for arteriovenous fistula: an endo-
scopic approach
. J Am Coll Surg
2001;
192
: 233-6.
11. Weyde W, Krajewska M, Letachowicz W, Kusztal M, Penar J, Klinger
M. A new technique for autogenous brachiobasilic upper arm transposi-
tion for vascular access for hemodialysis.
J Vasc Access
2006;
7
: 74–76.
12. Gelabert HA, Freischlag JA. Hemodialysis access. In: Rutherford RB
ed.
Vascular Surgery.
Philadelphia: WB Saunders, 2000: 1466–1477.
13. Turkish Society of Nephrology. Registry of the Nephrology, Dialysis
and Transplantation in Turkey. Registry 2004. Omega CRO.
İ
stanbul,
Turkey: Turkish Society of Nephrology; 2005 June.
14. Madran H, Ozgur B, Kursad S, Sakarya A, ErhanY, Aydede H. Vascular
interventions in chronic hemodialysis.
Türkiye Klinikleri Kalp Damar
Cer Derg
2001;
2
: 38–47.
15. Saritas B, Okyay K, Yilmazturk H. Perforating vein – brachial artery
anastomosis as an alternative to conventional arterio-venous fistulae
for hemodialysis: mid-term follow-up results.
Türkiye Klinikleri J
Cardiovasc Sci
2010;
22
(2): 200–205.
16. Basel H, Odabasi D, Akbayrak H. A-V fistula management between
