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- Title
Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas.
- Authors
Oliver, Matthew J.; Mccann, Richard L.; Indridason, Olafur S.; Butterly, David W.; Schwab, Steve J.
- Abstract
Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Background. Renewed interest in transposed brachiobasilic fistulas has occurred since the release of the National Kidney Foundation–Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines because it is an alternative method to achieve an upper arm fistula in patients who cannot achieve a functional brachiocephalic fistula. The objective of this study was to compare outcomes among transposed brachiobasilic fistulas, upper arm grafts, and brachiocephalic fistulas. Methods. A cohort of patients with upper arm accesses was retrospectively identified. Access outcomes were determined from medical records and contact with physicians, dialysis providers, and patients. Primary outcome was thrombosis-free survival. Secondary outcomes were primary failure, time to use, risk of catheter-related bacteremia, need for intervention, incidence of access-related complications, cumulative, and functional patency. Group differences in age, sex, race, diabetes, peripheral vascular disease, and number of previous accesses were adjusted for in the analysis where appropriate. Results. Transposed brachiobasilic fistulas, upper arm grafts, and brachiocephalic fistulas were compared in 59, 82, and 56 patients, respectively. Compared with transposed brachiobasilic fistulas, upper arm grafts were more likely to thrombose with an adjusted relative risk (RR) of 2.6 (95% CI, 1.3 to 5.3) excluding primary failures and 1.6 (95% CI, 1.0 to 2.7) when accounting for the lower risk of primary failure for grafts. Transposed brachiobasilic fistulas also required less intervention (0.7 vs. 2.4 per access-year, P < 0.01) and were less likely to become infected (0 vs. 13%, P < 0.05) than grafts. Mature brachiocephalic fistulas were less likely to fail (RR 0.3, 95% CI, 0.1 to 1.0) and showed a trend for less thrombosis (RR 0.3, 0.1 to 1.1) than mature brachiobasilic fistulas. There was no...
- Subjects
HEMODIALYSIS; FISTULA; DISEASES in African Americans
- Publication
Kidney International, 2001, Vol 60, Issue 4, p1532
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.2001.00956.x