Purpose
The aim of the study was to assess outcomes of brachiobasilic arteriovenous fi stula (BBAVF)
under ultrasound (US)-guided supraclavicular block with or without superfi cialization and of
brachiocephalic arteriovenous fi stula in patients with vessels unsuitable or failed for a forearm
fi stula.
Patients and methods
The study included 75 patients diagnosed with end-stage renal failure. They were divided
into three equal groups (n = 25) according to the site of fi stula: group 1 underwent BBAVF
(one-stage), group 2 underwent BBAVF (two-stage with 1-month interval), and group
3 underwent brachiocephalic arteriovenous fi stula, all with end-to-side anastomosis under
US-guided supraclavicular block.
Results
There was signifi cant difference in the diameter of arm veins between the fi rst two groups
and the third group (P = 0.01), especially using supraclavicular block. Despite group 1 had
the longest operative time (82.02 ± 11.39), it had the shortest duration of maturation and
the best mean fl ow rate (ml/min) (P = 0.0004 and 0.004, respectively). The frequency of
early postoperative complications — that is, primary access failure and early thrombosis
(fi rst 10 days) — and late complications — that is, late thrombosis more than 10 days and
pseudoaneurysm — was less in group 1 (P = 0.05).
Conclusion
Despite one-stage BBAVF takes long operative time, it appears to be the most ideal vascular
access, with high success rate, shortest duration of maturation, best mean fl ow rate, and less
postoperative complications, and surgical redo with its complications is also less especially
using US-guided supraclavicular block. |
