BACKGROUND: Vascular access is a necessity for patients with end-stage renal disease who need chronic intermittent hemodialysis. According to Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, radial-cephalic (RC) and brachial-cephalic (BC) arteriovenous fistulas (AVF) are the first and second choice for vascular access, respectively. If these options are not possible, an autogenous brachial-basilic fistula in the upper arm (BBAVF) or a prosthetic brachial-antecubital forearm loop (PTFE loop) may be considered. Until now, it was not clear which access type was preferable. We have performed a randomized study comparing BBAVF and prosthetic implantation in patients without the possibility for RCAVF or BCAVF. METHODS:Patients with failed primary/secondary access or inadequate arterial and/or venous vessels were randomized for either BBAVF or PTFE loop creation. The numbers of complications and interventions were recorded. Kaplan-Meier method was used to calculate primary, assisted-primary and secondary patency rates. The patency rates were compared with the log-rank test. Complication and intervention rates were compared with the Mann-Whitney test. RESULTS:A total of 105 patients were randomized for a BBAVF or PTFE loop (52 vs 53, respectively). Primary and assisted-primary 1-year patency rates were significantly higher in the BBAVF group: 46% +/- 7.4% vs 22% +/- 6.1% (P = .005) and 87% +/- 5.0% vs 71% +/- 6.7% (P = .045) for the BBAVF and PTFE group, respectively. Secondary patencies were comparable for both groups; 89% +/- 4.6% vs 85% +/- 5.2% for the BBAVF and PTFE group, respectively. The incidence rate of complications was 1.6 per patient-year in the BBAVF group vs 2.7 per patient-year in the PTFE group. Patients in the BBAVF group needed a total of 1.7 interventions per patient-year vs 2.7 per patient-year for the PTFE group. CONCLUSION: These data show a significantly better primary and assisted-primary patency in the BBAVF group compared with the PTFE group. Furthermore, in the BBAVF group, fewer interventions were needed. Therefore, we conclude that BBAVF is the preferred choice for vascular access if RCAVF or BCAVF creation is impossible, or when these types of access have already failed.
RCT Entities:
BACKGROUND: Vascular access is a necessity for patients with end-stage renal disease who need chronic intermittent hemodialysis. According to Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, radial-cephalic (RC) and brachial-cephalic (BC) arteriovenous fistulas (AVF) are the first and second choice for vascular access, respectively. If these options are not possible, an autogenous brachial-basilic fistula in the upper arm (BBAVF) or a prosthetic brachial-antecubital forearm loop (PTFE loop) may be considered. Until now, it was not clear which access type was preferable. We have performed a randomized study comparing BBAVF and prosthetic implantation in patients without the possibility for RCAVF or BCAVF. METHODS:Patients with failed primary/secondary access or inadequate arterial and/or venous vessels were randomized for either BBAVF or PTFE loop creation. The numbers of complications and interventions were recorded. Kaplan-Meier method was used to calculate primary, assisted-primary and secondary patency rates. The patency rates were compared with the log-rank test. Complication and intervention rates were compared with the Mann-Whitney test. RESULTS: A total of 105 patients were randomized for a BBAVF or PTFE loop (52 vs 53, respectively). Primary and assisted-primary 1-year patency rates were significantly higher in the BBAVF group: 46% +/- 7.4% vs 22% +/- 6.1% (P = .005) and 87% +/- 5.0% vs 71% +/- 6.7% (P = .045) for the BBAVF and PTFE group, respectively. Secondary patencies were comparable for both groups; 89% +/- 4.6% vs 85% +/- 5.2% for the BBAVF and PTFE group, respectively. The incidence rate of complications was 1.6 per patient-year in the BBAVF group vs 2.7 per patient-year in the PTFE group. Patients in the BBAVF group needed a total of 1.7 interventions per patient-year vs 2.7 per patient-year for the PTFE group. CONCLUSION: These data show a significantly better primary and assisted-primary patency in the BBAVF group compared with the PTFE group. Furthermore, in the BBAVF group, fewer interventions were needed. Therefore, we conclude that BBAVF is the preferred choice for vascular access if RCAVF or BCAVF creation is impossible, or when these types of access have already failed.
Authors: Jacques Greenberg; Senthil Jayarajan; Sridhar Reddy; Frank A Schmieder; Andrew B Roberts; Paul S van Bemmelen; Jean Lee; Eric T Choi Journal: Vasc Endovascular Surg Date: 2017-01-01 Impact factor: 1.089
Authors: Tushar J Vachharajani; Louise M Moist; Marc H Glickman; Miguel A Vazquez; Kevan R Polkinghorne; Charmaine E Lok; Timmy C Lee Journal: Nat Rev Nephrol Date: 2013-12-03 Impact factor: 28.314
Authors: Pietro Ravani; Brenda W Gillespie; Robert Ross Quinn; Jennifer MacRae; Braden Manns; David Mendelssohn; Marcello Tonelli; Brenda Hemmelgarn; Matthew James; Neesh Pannu; Bruce M Robinson; Xin Zhang; Ronald Pisoni Journal: J Am Soc Nephrol Date: 2013-07-11 Impact factor: 10.121
Authors: Stavros K Kakkos; Ioannis A Tsolakis; Spyros I Papadoulas; George C Lampropoulos; Evangelos E Papachristou; Nikolaos C Christeas; Dimitrios Goumenos; Miltos K Lazarides Journal: Front Surg Date: 2015-04-29