A comparison between one-stage and two-stage procedures for the creation of brachiobasilic arteriovenous fistulas

• Native arteriovenous fistulas have better outcomes compared to prosthetics grafts.
• Patients require multiple vascular access attempts due to poor fistula survival.
• Little evidence to compare surgical techniques in creating brachiobasilic fistulas.
• We report creating brachiobasilic fistulas in two-stages may improve patency rates.
• Fistuloplasties and embolectomies were highly effective in fistula salvage.

IntroductionVascular access is essential to end-stage renal failure patients requiring haemodialysis. Many patients require multiple fistula formation attempts in order to gain good access, making secondary and tertiary fistula options vital. Brachiobasilic fistulas are well established, but there is little evidence to compare the different surgical techniques in creating them. This study aimed to determine the patency and complication rates associated with these procedures.MethodsRetrospective data was collected by reviewing case notes to determine fistula survival time and surgical setting. Patency, complications and required interventions were recorded for each group at three time intervals. The Kaplan–Meier method was used to calculate survival for each cohort.Results37 brachiobasilic arteriovenous fistulas were created in 35 patients. 17 fistulas were one-stage procedures; 20 fistulas were made in two stages. Survival proportions were measured as 70.6%, 58.8% and 51.5% for the one-stage procedure and 95%, 90% and 78% for the two-stage procedure at 1 month, 1 year and 2 years respectively with p = 0.0385.DiscussionNative brachiobasilic fistulas have advantages over prosthetic grafts. There are technical aspects which make the two-staged procedure preferable, including being more amenable to a day case surgery setting. Despite this, there is a lack of relative outcome differences in the literature, thus necessitating further work.ConclusionOur data suggests creation of brachiobasilic fistulas using a two-staged procedure may result in improved patency rates. Complication rates were found to be statistically equivocal, with fistuloplasties and embolectomy shown to be effective in fistula salvage.