title: Similar failure and patency rates when comparing one- and two-stage basilic vein transposition.
abstract: OBJECTIVE
  Basilic vein transposition is recommended in patients who are not candidates for a radial or brachial artery to cephalic vein fistula for dialysis access. Both one-stage and two-stage procedures have their advantages and disadvantages. Which procedure results in improved outcomes remains unclear.
  
  
  METHODS
  A systematic review was conducted of the MEDLINE and EMBASE databases for studies that compared one-stage and two-stage brachial-basilic vein transpositions. Abstracts and full-text studies were screened independently by two reviewers with data abstraction done in duplicate. Random-effects meta-analysis was used to identify differences in primary failure rates and 1-year primary and secondary patency rates. Study quality was assessed by a previously described tool designed for observational studies reporting on dialysis access outcomes.
  
  
  RESULTS
  Of 1662 abstracts screened, 97 were selected for full-text review. Of these, eight studies (one randomized trial, seven observational studies) involving 882 patients met the inclusion criteria. The pooled odds ratio estimate for primary failure was 1.21 (95% confidence interval [CI], 0.73-1.98; P = .46), suggesting no difference in failure rate between one-stage and two-stage transpositions. Similarly, the estimated odds ratio for 1-year primary patency rate of 1.39 (95% CI, 0.71-2.72; P = .33) and 1-year secondary patency rate of 1.02 (95% CI, 0.36-2.87; P = .98) indicated no difference between the two groups. Study quality was limited by unclear outcome definitions, minimal control for confounding, and variable selection criteria. The decision to pursue a one-stage vs a two-stage procedure was often based on size of the basilic vein, with a two-stage procedure reserved for patients with smaller veins.
  
  
  CONCLUSIONS
  Meta-analysis of the existing literature comparing one-stage and two-stage basilic vein transposition suggests no difference in failure and patency rates, despite the two-stage procedure's being used in patients with smaller basilic veins. These findings are limited by the small size, observational design, and inconsistent quality of included studies. Reserving a two-stage procedure for patients with smaller basilic veins appears justified, although the strength of the evidence is limited.
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Cooper
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Power
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: DeRose
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
authors.affiliation: Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: Luc.Dubois@lhsc.on.ca.
authors.forename: Luc
authors.initials: L
authors.lastname: Dubois
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D016017:Odds Ratio; D006435:Renal Dialysis; D019233:Retreatment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000601:surgery