title: A comparison between one- and two-stage brachiobasilic arteriovenous fistulas.
abstract: OBJECTIVE
  Brachiobasilic arteriovenous fistulas (BBAVF) can be performed in one or two stages. We compared primary failure rates, as well as primary and secondary patency rates of one- and two-stage BBAVF at two institutions.
  
  
  METHODS
  Patients undergoing one- and two-stage BBAVF at two institutions were compared retrospectively with respect to age, sex, body mass index, use of preoperative venous duplex ultrasound, diabetes, hypertension, and cause of end-stage renal disease. Categorical variables were compared using chi-square and Fisher's exact test, whereas the Wilcoxon rank-sum test was used to compare continuous variables. Patency rates were assessed using the Kaplan-Meier survival analysis and the Cox proportional hazards model with propensity analysis to determine hazard ratios.
  
  
  RESULTS
  Ninety patients (60 one-stage and 30 two-stage) were identified. Mean follow-up was 14.2 months and the mean time interval between the first and second stage was 11.2 weeks. Although no significant difference in early failure existed (one-stage, 22.9% vs two-stage, 9.1%; P = .20), the two-stage BBAVF showed significantly improved primary functional patency at 1 year at 88% vs 61% (P = .047) (hazard ratio, 0.2 (95% confidence interval [CI], .04-.80; P = .03). Patency for one-stage BBAVF markedly decreased to 34% at 2 years compared with 88% for the two-stage procedure (P = .047). Median primary functional patency for one-stage BBAVF was 31 weeks (interquartile range [IQR], 11-54) vs 79 weeks (IQR, 29-131 weeks) for the two-stage procedure, respectively (P = .0015). Two-year secondary functional patency for one- and two-stage procedures were 41% and 94%, respectively (P = .015).
  
  
  CONCLUSIONS
  Primary and secondary patency at 1 and 2 years as well as functional patency is improved with the two-stage BBAVF when compared with the one-stage procedure. Lower primary failure rates prior to dialysis with the two-stage procedure approached, but did not reach statistical significance. While reasons for these finding are unclear, certain technical aspects of the procedure may play a role.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
authors.forename: Tyler S
authors.initials: TS
authors.lastname: Reynolds
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zayed
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kim
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lee
authors.forename: Brandon
authors.initials: B
authors.lastname: Ishaque
authors.forename: Ramanath B
authors.initials: RB
authors.lastname: Dukkipati
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014654:Vascular Patency