CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 248 AFRICA The use of brachiobasilic arteriovenous fistulae for haemodialysis: a single-centre descriptive study Tinus du Toit, Kenward Chibuye, David Thomson, Kathryn Manning Abstract Aim: The main aim of the study was to report on our local experience with the use of brachiobasilic arteriovenous fistulae (BBAVF) and to encourage wider local acceptance of the procedure in accordance with international guidelines. The primary aim was to report on access patency. The secondary aims were to report on functional outcomes and complications. Methods: This was a retrospective, descriptive study of 41 consecutive haemodialysis patients who underwent BBAVF creation. Results: The primary patency rates at 30 days, and one and three years were 95.1, 48.8 and 19.5%, respectively. Assisted primary patency rates at 30 days, and one and three years were 100, 67.7 and 24.3%, respectively. Secondary patency rates at 30 days, and one and three years were 100, 70.3 and 27%, respectively. Conclusion: BBAVF creation can successfully be performed in a resource-constrained environment by surgeons with limited prior experience with the technique. However, careful monitoring, well-established referral pathways for dysfunctional fistulae and access to surgical and endovascular revision seem to be key factors in ensuring long-term patency. Keywords: brachiobasilic, arteriovenous, fistula, haemodialysis, one-stage, two-stage Submitted 6/3/21; accepted 1/2/22 Published online 29/6/22 Cardiovasc J Afr 2022; 33: 248–253 www.cvja.co.za DOI: 10.5830/CVJA-2022-006 An exponential rise in chronic kidney disease in sub-Saharan Africahas beenprojectedover thenext decadedue to the escalating dual burden of communicable and non- communicable diseases.1 For the majority of patients who have progressed to end-stage kidney disease (ESKD), kidney transplantation will improve survival, decrease cost and improve quality of life compared to dialysis.2 However, with a low annual kidney transplant rate of 0.7 per million population (pmp), predominantly limited by a low annual deceased donor rate of 0.1 pmp, most patients with ESKD on the African continent depend heavily on the safe and effective administration of dialysis to achieve long-term survival.3 Within this context, the implementation of clinical practice guidelines, quality assessment, research and education in the field of dialysis access may be considered even more crucial and relevant than in regions with better access to transplantation. The goal of vascular access is to provide repetitive and reliable access to the circulation, while minimising complications. Practice guidelines from several international vascular access societies endorse the radiocephalic arteriovenous (AV) fistula as the first site of creation of peripheral vascular access, followed by the brachiocephalic AV fistula, provided the target vessels are suitable.4-6 Based on superior outcomes, brachiobasilic arteriovenous fistulae (BBAVF) should be considered above AV grafts, as the third option in the creation of peripheral vascular access.4-6 Despite these guidelines, AV grafts are at times performed inappropriately early and may, in some instances, decrease the likelihood of future successful BBAVF creation. The perceived complexity of the BBAVF procedure might be the reason why some access surgeons prefer AV graft creation. By reporting on our local results with the use of BBAVF, and by reviewing the technical aspects of this procedure, as well as the pitfalls, we anticipate wider local acceptance of this procedure for suitable candidates, in accordance with international guidelines. Methods The study was approved by the University of Cape Town’s Human Research Ethics Committee (reference number 794/2017) and included a waiver of informed consent as only anonymised registry data were used to perform the study. This was a retrospective, descriptive study of 41 consecutive haemodialysis patients who underwent BBAVF creation at Groote Schuur Hospital from 1 January 2014 to 24 April 2020. The patients were identified from a prospectively maintained operative database and reviewed retrospectively. The primary aim of the study was to report on access patency, including primary, assisted primary and secondary patency at 30 days, and one and three years. The secondary aims were to report on functional outcomes and complications with the use of this technique. All patients underwent pre-operative ultrasound assessment to assess the quality and size of the target vessels, in keeping with the standard of care. BBAVF were only considered in cases where the superficial veins were not suitable for AV fistula creation and where both the brachial artery and basilic vein diameters exceeded 2.5 mm. All procedures were performed by general surgeons trained in vascular access, using the same surgical technique. Primary patency was defined as the interval from access creation to the first intervention intended to maintain or re-establish adequate access flow (intervention-free interval). Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa Tinus du Toit, MMed, tinus.dutoit@uct.ac.za Kenward Chibuye, MB ChB David Thomson, MMed Kathryn Manning, MSc (Med)
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