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Amid the growing methodological heterogeneity in TBBAVF, studies have been performed in an attempt to clarify the optimal procedure for TBBAVF construction. In a recent meta-analysis, Jun Yan Wee et al. [15] assessed 12 comparative studies between one- and two-stage TBBAVF (2 RCTs and 10 cohort studies involving 1,135 patients) and found that the two-stage procedure had significantly better 2-year primary patency rates; however, there were no statistically significant differences in the failure rates, 1-year primary and secondary patency rates, and 2-year secondary patency rates between the 2 groups. Their meta-analysis also showed no differences in the time to first fistula use or complication rates of steal syndrome, hematoma, infection, pseudoaneurysm, or stenosis between the 2 procedures. These results indicate the potential benefits of the two-stage versus one-stage procedure for construction of a TBBAVF [15] (Table 2). The superficialized basilic vein in the two-stage procedure could conceivably be associated with a reduced risk of kinking, twisting, or compression in the relocated subcutaneous space because of the sufficient interval for venous arterialization and wall thickening. An additional advantage of the two-stage technique is that the development of complications such as steal syndrome or venous hypertension after the arteriovenous anastomoses in the first stage could be managed before superficialization [16].

Table 2. Recent comparative studies of methodological differences in TBBAVF