Brachial vein transposition: an alternative to hemodialysis arteriovenous graft

Abstract Background There is currently a worldwide effort to increase the options for autogenous hemodialysis access. Objectives To evaluate patency and complications of brachial vein transposition compared to other autogenous hemodialysis accesses. Methods A retrospective evaluation of 43 patients and 45 procedures. Patients who did not have adequate superficial veins according to duplex scanning were allocated to brachial vein transposition. The sample was thus divided in two groups, as follows: A: brachial vein transposition n=10 and B: other autogenous accesses n=35. Results There were no statistical differences between the two groups in terms of age diabetes, systemic arterial hypertension, dyslipidemias, arteriopathies, neoplasms, kidney disease stage, donor artery diameter, recipient vein diameter, systolic blood pressure in the operated limb, postoperative ischemia, hematoma, or infection. There were no statistical differences in terms of patency on day 7: A 80% vs. B 90% p=0.6, on day 30: A 80% vs. B 86% p=0.6, or on day 60: A 60% vs. B 80% p=0.22. There were statistical differences between the groups for number of previous fistulae A 1.0 ± 0.44 vs. B 0.6 ± 0.3 p = 0.04 and upper limb edema A: 20% x B 0% p = 0.04. A vein with diameter of less than 3 mm was associated with an increased risk of early occlusion (RR = 8 p = 0.0125). During the study period there were no procedures using grafts. Conclusions Transposition of brachial vein is an alternative to arteriovenous graft.

摘要
背景：当前全球范围内正致力于拓展自体血液透析通路（autogenous hemodialysis access）的可选方案。
研究目的：对比肱静脉转位术（brachial vein transposition）与其他自体血液透析通路的通畅率及并发症发生情况。
研究方法：本研究为回顾性分析，共纳入43例患者、45例手术操作。经双功超声扫描（duplex scanning）确认浅静脉条件不足的患者，被纳入肱静脉转位术组。据此将研究对象分为两组：A组为肱静脉转位术组（n=10），B组为其他自体通路组（n=35）。
研究结果：两组患者在年龄、糖尿病、系统性动脉高血压、血脂异常、动脉病变、肿瘤、肾病分期、供体动脉直径、受体静脉直径、术侧肢体收缩压、术后缺血、血肿或感染发生率方面，均无统计学差异。术后7天、30天及60天的通畅率方面，两组均无统计学差异：术后7天A组80% vs B组90%（p=0.6）；术后30天A组80% vs B组86%（p=0.6）；术后60天A组60% vs B组80%（p=0.22）。但两组在既往动静脉瘘数量（A组1.0±0.44 vs B组0.6±0.3，p=0.04）及上肢水肿发生率（A组20% vs B组0%，p=0.04）方面存在统计学差异。静脉直径小于3mm与早期闭塞风险升高相关（相对风险RR=8，p=0.0125）。本研究期间未采用移植物类手术操作。
研究结论：肱静脉转位术可作为动静脉移植物（arteriovenous graft）的替代方案。