Outcomes of single or two-stage brachiobasilic arteriovenous fistula: a Nationwide Swedish Registry study

Selected in ESVS Journal by Mathis Bodin

This nationwide Swedish registry study compared one- and two-stage brachiobasilic arteriovenous fistula procedures in adult patients. While the two-stage approach showed superior primary patency, it came at the cost of a longer delay before functional use. In the long term, both techniques performed similarly—highlighting the importance of tailoring the surgical strategy to each patient’s context.

References:

Authors: Gunilla Welandera, Fredrik Lundin,∙Hawshin Palanjafic, Birgitta Sigvant

Reference: Welander et All. European Journal of Vascular and Endovascular Surgery 2025

DOI: 10.1016/j.evjs.2024.12.027

Read the abstract

Objective:

The objective was to determine whether functional outcomes favoured the one- or two-stage procedure for the creation of a basilic vein arteriovenous transposition fistula.

Study:

Retrospective and observational study based on the Swedish National Renal Registry.

Population:

Patients aged of 18 years or more and who underwent the creation of a brachiobasilic arterioveinous fistula were included.

Outcomes and conclusion:

This observational and retrospective study highlights the superior primary patency of the two-stage procedure counterbalanced by a longer time before functional use of the fistula. The long-term patency was equivalent for the two surgical techniques. Thus, the surgical procedure chosen needs to be adapted to the patient and the context.

: Outcomes of Single or Two Stage Brachiobasilic Arteriovenous Fistula : A Nationwide Swedish Registry Study

Source: ESVS Journal

Comments:

Key findings from the study

When comparing the two surgical approaches:

The two-stage procedure was associated with fewer re-interventions, but required a longer time before the first puncture and fistula use.
Despite this, the overall rate of re-interventions remained significant.
Fistula abandonment rates were low in both groups, raising the question of whether there may be more salvage attempts with one-stage procedures.

Impact of female sex

Higher rates of re-interventions and abandonment were observed in women.
This could be related to differences in vein elasticity or smaller arterial diameter.

Study limitations

The study was retrospective and observational in nature.
Lack of intraoperative data, such as surgical techniques used and vessel condition, limited deeper analysis.

Importance of post-creation management

80 % of fistulas in the two-stage group underwent superficialisation.
Around one-third of fistulas remained unused in both groups—raising questions about whether use was attempted too early or too late.