A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas
Purpose: There is currently debate if brachio-basilic vein fistula (BBVF) should be performed as a one-stage or two-stage procedure. The aim of the present study was to perform a systematic review and meta-analysis on BBVF staging. Materials and Methods: On February 25, 2016, a search for randomi...
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doaj-ddb8d413a9a447a78435f9b60a1b95ab2020-11-25T02:06:58ZengMedrang Vascular Specialist International2288-79702018-09-01343516010.5758/vsi.2018.34.3.51vsi.2018.34.3.51A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein FistulasStavros K. Kakkos0George C. Lampropoulos1Konstantinos M. Nikolakopoulos2Ioannis A. Tsolakis3Spyros I. Papadoulas4Evangelos C. Papachristou5Dimitrios Goumenos6Miltos K. Lazarides7Department of Vascular Surgery, University Hospital of Patras, Patras, GreeceDepartment of Vascular Surgery, University Hospital of Patras, Patras, GreeceDepartment of Vascular Surgery, University Hospital of Patras, Patras, GreeceDepartment of Vascular Surgery, University Hospital of Patras, Patras, GreeceDepartment of Vascular Surgery, University Hospital of Patras, Patras, GreeceDepartment of Nephrology, University Hospital of Patras, Patras, GreeceDepartment of Nephrology, University Hospital of Patras, Patras, GreeceDepartment of Vascular Surgery, Democritus University Hospital, Alexandroupolis, GreecePurpose: There is currently debate if brachio-basilic vein fistula (BBVF) should be performed as a one-stage or two-stage procedure. The aim of the present study was to perform a systematic review and meta-analysis on BBVF staging. Materials and Methods: On February 25, 2016, a search for randomized-controlled trials (RCTs) on BBVF procedures was performed in MEDLINE and Scopus databases. Meta-analyses were performed with fixed-effect or random-effects models as appropriate with risk ratios (RRs). The primary efficacy and safety outcome measures were BBVF maturation and development of complications, respectively. Specific types of complications, including loss of functional secondary patency and long-term complications were all secondary outcome measures. Results: We identified three RCTs reporting on 126 patients. Maturation failure of two-stage BBVFs (3/47, 6.4%) was less frequent than one-stage BBVFs (16/79, 20.3%; RR, 0.27; P=0.02). Complication rates of two-stage and one-stage BBVFs were similar (RR, 0.80; P=0.54), but on sensitivity analysis these were less likely to occur with two-stage BBVFs (37% vs. 69% for one-stage BBVFs; RR, 0.57; P=0.03). Two-stage BBVFs were less likely to lose their functional secondary patency (21.3% vs. 31.6% for one-stage BBVFs; RR, 0.61; P=0.11). This non-significant trend became significant (RR, 0.36; P=0.02) on sensitivity analysis. There was no difference in specific complication rates of the two study groups. Conclusion : Among candidates for BBVF fistula, there is evidence to suggest that two-stage BBVFs achieve higher maturation rates compared to one-stage BBVFs. The evidence for difference in long-term secondary patency is less robust, calling for further research.http://www.vsijournal.org/journal/view.html?doi=10.5758/vsi.2018.34.3.51Brachio-basilicArteriovenous fistulaRenal dialysisSurgical technique |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stavros K. Kakkos George C. Lampropoulos Konstantinos M. Nikolakopoulos Ioannis A. Tsolakis Spyros I. Papadoulas Evangelos C. Papachristou Dimitrios Goumenos Miltos K. Lazarides |
spellingShingle |
Stavros K. Kakkos George C. Lampropoulos Konstantinos M. Nikolakopoulos Ioannis A. Tsolakis Spyros I. Papadoulas Evangelos C. Papachristou Dimitrios Goumenos Miltos K. Lazarides A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas Vascular Specialist International Brachio-basilic Arteriovenous fistula Renal dialysis Surgical technique |
author_facet |
Stavros K. Kakkos George C. Lampropoulos Konstantinos M. Nikolakopoulos Ioannis A. Tsolakis Spyros I. Papadoulas Evangelos C. Papachristou Dimitrios Goumenos Miltos K. Lazarides |
author_sort |
Stavros K. Kakkos |
title |
A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas |
title_short |
A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas |
title_full |
A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas |
title_fullStr |
A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas |
title_full_unstemmed |
A Systematic Review and Meta-Analysis of Randomized Trials Comparing Two-Stage with One-Stage Brachio-Basilic Vein Fistulas |
title_sort |
systematic review and meta-analysis of randomized trials comparing two-stage with one-stage brachio-basilic vein fistulas |
publisher |
Medrang |
series |
Vascular Specialist International |
issn |
2288-7970 |
publishDate |
2018-09-01 |
description |
Purpose: There is currently debate if brachio-basilic vein fistula (BBVF) should be performed as a one-stage or two-stage procedure. The aim of the present study was to perform a systematic review and meta-analysis on BBVF staging.
Materials and Methods: On February 25, 2016, a search for randomized-controlled trials (RCTs) on BBVF procedures was performed in MEDLINE and Scopus databases. Meta-analyses were performed with fixed-effect or random-effects models as appropriate with risk ratios (RRs). The primary efficacy and safety outcome measures were BBVF maturation and development of complications, respectively. Specific types of complications, including loss of functional secondary patency and long-term complications were all secondary outcome measures.
Results: We identified three RCTs reporting on 126 patients. Maturation failure of two-stage BBVFs (3/47, 6.4%) was less frequent than one-stage BBVFs (16/79, 20.3%; RR, 0.27; P=0.02). Complication rates of two-stage and one-stage BBVFs were similar (RR, 0.80; P=0.54), but on sensitivity analysis these were less likely to occur with two-stage BBVFs (37% vs. 69% for one-stage BBVFs; RR, 0.57; P=0.03). Two-stage BBVFs were less likely to lose their functional secondary patency (21.3% vs. 31.6% for one-stage BBVFs; RR, 0.61; P=0.11). This non-significant trend became significant (RR, 0.36; P=0.02) on sensitivity analysis. There was no difference in specific complication rates of the two study groups.
Conclusion : Among candidates for BBVF fistula, there is evidence to suggest that two-stage BBVFs achieve higher maturation rates compared to one-stage BBVFs. The evidence for difference in long-term secondary patency is less robust, calling for further research. |
topic |
Brachio-basilic Arteriovenous fistula Renal dialysis Surgical technique |
url |
http://www.vsijournal.org/journal/view.html?doi=10.5758/vsi.2018.34.3.51 |
work_keys_str_mv |
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