ABSTRACT
AIM: The aim of this paper was to compare the outcomes of patients undergoing autogenous brachial-basilic upper arm transposition fistulas (BBAVF) with prosthetic brachial-axillary vascular accesses (BAPTFE) at immediate and medium follow-up. METHODS: Retrospective analysis of the aforementioned accesses performed in a single-center from 2003 to 2007. Transposition was used in all BBAVF performed. Conic prostheses were used in the BAPTFE. Primary and secondary patency, patient survival, types of complications and its rates were assessed during follow-up. RESULTS: Thirty-six BBAVF and 40 BAPTFE were performed. Both groups were well matched for age, gender and comorbidity. BBAVF primary patency was 93.5%, 50.4%, 45.8% and 45.8% compared to 80.6%, 64.3%, 46.2% and 31.6% of the BAPTFE group at 1, 12, 24 and 36 months of follow-up (P=0.719). BBAVF secondary patency was 93.5%, 50.4%, 45.8% and 45.8% compared to 80.6%, 67.7%, 54.2% and 35.1% of the BAPTFE at the same periods (P=0.902). Patient survival was 97.2%, 97.2%, 93.2% and 86.5 for BBAVF in contrast to 97.2%, 94.4%, 84.1% and 79.9% for BAPTFE in the same months (P=0.386). 13.8% of the BBVAF had accessibility problems while only 5% of the BAPTFE presented them (P=0.174). Infection was more frequent in BAPTFE (0% vs 10%), being the only complication near the statistical signification (P=0.071). CONCLUSION: BBAVF offer patency and accessibility rates similar to BAPTFE, but lower infectious complications. Thus, we consider them as the preferred hemodialysis access when fistulas using the cephalic vein have failed or are not possible.
Subject(s)
Arteriovenous Shunt, Surgical/methods , Axillary Vein/surgery , Blood Vessel Prosthesis Implantation , Brachial Artery/surgery , Renal Dialysis , Upper Extremity/blood supply , Adult , Aged , Aged, 80 and over , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/instrumentation , Arteriovenous Shunt, Surgical/mortality , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Chi-Square Distribution , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Patient Selection , Prosthesis-Related Infections/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Spain , Surgical Wound Infection/etiology , Time Factors , Treatment Outcome , Vascular Patency , Young AdultABSTRACT
Objetivo. La claudicación intermitente en el adulto joven (CIAJ) de etiología no arteriosclerótica es una entidad poco frecuente, lo que provoca, en muchas ocasiones, retrasos diagnósticos en pacientes generalmente activos, con la consiguiente incapacidad y pérdida de productividad. El objetivo de este artículo es describir los distintos procesos no arterioscleróticos que pueden provocar claudicación intermitente (CIN) en este grupo de pacientes, y hacer hincapié en sus características diferenciales. Desarrollo. Se describen las patologías no arterioscleróticas que pueden producir CIAJ; se considera adulto joven aquel con menos de 40 años de edad. Se excluyen las vasculitis, debido a su afectación sistémica, con excepción de la tromboangitis obliterante y la enfermedad de Takayasu, por presentarse, en muchas ocasiones, únicamente con claudicación. Se incluyen las anomalías del desarrollo embriológico: atrapamiento poplíteo (AP), enfermedad quística adventicial y arteria ciática persistente; las estenosis y obstrucciones de la aorta abdominal: coartación aórtica, hipoplasia aórtica y enfermedad de Takayasu; las lesiones arteriales de los deportistas: AP funcional, síndrome del canal de los aductores, disección de la ilíaca externa, endofibrosis de la ilíaca externa y síndrome compartimental crónico; el ergotismo; la tromboangitis obliterante; y otras: displasia fibromuscular, obstrucción traumática y arteritis actínicas. Conclusiones. El conocimiento de las distintas causas de CIN no arteriosclerótica en el adulto joven evita demoras diagnósticas y permite un tratamiento precoz, lo que facilita la reincorporación temprana de este grupo de pacientes a su actividad habitual (AU)
