CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
365
the axillary area. The vein was carried over the fascia by tying
the lateral branches during the release of the basilic vein, while
the
nervus cutaneus medialis
of the forearm was preserved.
Following the evaluation of the presence of thrill, the fascia
and others were closed in anatomical layers, lifting the vein and
protecting the nerve. Patients whose wounds had healed after a
month underwent HD.
Postoperative complications of one- and two-stage BVT,
including primary and secondary patency rates, thrombosis,
haemorrhage, haematoma, infection and venous aneurysm were
retrospectively analysed.
Statistical analysis
Statistical analysis was performed using Windows SPSS 14.0
(SPSS Inc, Chicago, IL, USA). Normally distributed data,
which were expressed as mean
±
standard deviation, were
assessed using the
t
-test. The Kolmogorov-Smirnov test was
used to analyse normal distribution of the numerical data.
Categorical data were examined by Fischer’s exact test. The dual
logistic regression test was used to assess the effects of clinical
parameters such as haematoma or fistula maturation. A
p
-value
of
<
0.05 was considered statistically significant.
Results
While 28 (59%) patients were male and 19 (41%) were female
in group 1, 36 (61%) were male and 23 (39%) were female
in group 2. The mean follow up was 36 months. The means
of age, duration of ESRF, number of AVFs, patency duration,
co-morbidities and diameter of the basilic vein and brachial
artery are shown in Table 1.
The diameter of the operated basilic vein was significantly
higher in group 1 (3.46
±
0.2 mm), than in group 2 (2.79
±
0.1 mm) (
p
<
0.05). There was no significant difference in the
diameter of the brachial artery between the groups. Bleeding–
clotting times of the groups are shown in Table 2 and there was
no significant difference.
The ratio of fistula maturation, as well as postoperative
mortality and morbidity rates are shown in Table 3. There was
no significant difference in mortality rate, whereas a significant
difference was found in morbidity between the groups (
p
<
0.05).
The rate of fistula maturation was significantly lower in group 1
(66%) compared to group 2 (77%) (
p
<
0.05). The mean time to
fistula maturation was 41
±
14 days in group 1, while it was 64
±
28 days in group 2, indicating a significant difference between
the groups (
p
<
0.05).
With regard to auxiliary interventions, the rate of intervention
for early (
≤
10 days) fistula thrombosis was significantly higher
in group 1 (21%) compared to group 2 (12%). However, there
was no significant difference in rate of intervention for late (
≥
10 days) fistula thrombosis between the groups (20% in group
1; 22% in group 2). The number of auxiliary interventions
to manage haemorrhage and haematoma following fistula
formation was significantly higher in group 1 (17%, 10%) than
in group 2 (6%, 2%) (
p
<
0.05). Auxiliary surgical interventions
are summarised in Table 4.
Primary and secondary patency rates in both groups are
shown in Tables 5 to 8. Statistical comparisons of primary/
secondary patency rates between the groups are shown in Figs
1 and 2.
Discussion
Patients with ESRFmust receiveHD to survive, until they undergo
renal transplantation. AVF surgery to supply extracorporeal
blood flow has been performed for many years during HD.
12
The
TABLE 1. DEMOGRAPHICS OF THE PATIENTS
Variables
Group 1
one-stage BVT
(
n
=
47)
Group 2
two-stage BVT
(
n
=
59)
p
-value
Gender (M/F)
M
=
28 (59%) M
=
36 (61%)
NS
F
=
19 (41%)
F
=
23 (39%)
NS
Mean age (years)
M
=
43.1 (
±
16) M
=
44.9 (
±
14)
NS
F
=
42.5 (
±
13) F
=
44.1 (
±
13)
NS
ESRF duration (months)
M
=
63.1 (
±
17) M
=
61.7 (
±
20)
NS
F
=
64.5 (
±
18) F
=
63.3 (
±
21)
NS
Previously opened AVF
M
=
5 (
±
1.6)
M
=
5.2 (
±
1.7)
NS
F
=
5.45 (
±
1.7) F
=
5.0 (
±
1.6)
NS
Hypertension
15
14
NS
Diabetes mellitus
9
11
NS
Heart disease
4
3
NS
Peripheral vascular disease
2
3
NS
Smoking
9
11
NS
Mean LDL-C (mmol/l)
157
±
26
145
±
21
NS
Mean basilic vein diameter (mm)
3.46
±
0.2
2.79
±
0.1
<
0.05
Mean brachial artery diameter (mm)
3.71
±
1.4
3.63
±
1.5
NS
BVT: basilic vein transposition, AVF: arteio-venous fistula, NS: non-significant,
LDL-C: low-density lipoprotein cholesterol, ESRF: end-stage renal failure, M
=
male, F
=
female.
TABLE 2. BLEEDING–CLOTTINGTIMES OF THE GROUPS
Variables
Group 1 one-stage
BVT (
n
= 47)
Group 2 two-stage
BVT (
n
= 59)
PT (sec)
17
±
4
16
±
4
NS
APTT (sec)
38
±
7
41
±
7
NS
INR
1.3
±
0.5
1.5
±
0.7
NS
Platelet count (10
3
/ml)
385
±
70
367
±
67
NS
Bleeding time (min)
6.1
±
1.3
5.7
±
1.2
NS
Clotting time (min)
7.1
±
2.3
7.3
±
2.1
NS
Protein C (%)
89
±
28
92
±
31
NS
D-dimer (ng/dl)
275
±
73
321
±
67
NS
Fibrinogen (g/l)
3.2
±
0.7
2.8
±
0.5
NS
PT: prothrombin time, APTT: active partial thromboplastin time, INR: international
normalised ratio.
TABLE 3. COMPLICATIONS
Variables
Group 1
one-stage BVT
(
n
=
47)
Group 2
two-stage BVT
(
n
=
59)
p
-value
Mortality
3 (6%)
2 (4%)
NS
Maturation rate
31 (66%)
45 (77%)
<
0.05
Infection
6 (12%)
5 (10%)
NS
Thrombosis
16 (34%)
11 (23%)
<
0.05
Bleeding
17 (36%)
7 (14%)
<
0.05
Haematoma
8 (17%)
3 (6%)
<
0.05
Pseudo-aneurysm
2 (4%)
3 (6%)
NS
Steal syndrome
4 (8%)
3 (6%)
NS
Oedema
5 (10%)
6 (10%)
NS
Mean fistula maturation time (day)
41
±
14
64
±
28
<
0.05
Mean fistula flow rate (ml/min)
280
±
23
300
±
31
NS
NS: non-significant.
