DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164543

Comparative analysis of radiocephalic versus brachiocephalic native arteriovenous fistula for hemodialysis in end stage renal disease

Aniket Khadatkar, Chandrashekhar Mahakalkar, Tanu Pradhan, Akshay Bora

Abstract


Background: Chronic kidney disease (CKD) is a long term condition caused by damage to both kidneys. The benefits of arteriovenous fistulas over other forms of chronic access are: Arteriovenous fistulas are associated with decreased morbidity and mortality among hemodialysis patients compared with arteriovenous grafts and central venous catheters. Objectives of the study were o choose the proper sites for formation of arteriovenous fistula, to find out the success rate at various sites and to study the complications of arteriovenous fistula.

Methods: This prospective study was carried out on total 150 patients over the duration of two years. The fistulae were created using radial artery and cephalic vein side to side (Radiocephalic AVF) and brachial artery and cephalic vein side to side anastomosis (Brachiocephalic AVF). Doppler studies were done before and after every procedure to demonstrate the velocity, volume of blood flow, depth from the skin, diameter of vessels and to access the time of maturation of AVF. Patients were followed up to first dialysis by AVF to assess the overall outcomes and various complications.

Results: Brachiocephalic AVF matured earlier than Radiocephalic AVF (mean maturation time Brachiocephalic 38.02 days and Radiocephalic 43.26 days) which was statistically significant. Brachiocephalic AVF matured earlier than Radiocephalic AVF with more flow rate. Complication rate was more at wrist (Radiocephalic AVF with 66.67% of overall complication) than at elbow (Brachiocephalic AVF with 33.33% of overall complication).

Conclusions: We concluded that the Brachiocephalic AVF maturation time was significantly less than the maturation time of Radiocephalic AVF and rate of complication was less in Brachiocephalic AVF. The utility of pre-operative colour Doppler to select the vessels for AVF creation was found to be as an essential parameter of pre-operative work up.


Keywords


Brachiocephalic arteriovenous fistula, Colour Doppler, Complications, Hemodialysis, Maturation time, Radiocephalic arteriovenous fistula

Full Text:

PDF

References


John R, Webb M, Young A, Stevens PE. Unreferred chronic kidney disease: a longitudinal study. Am J Kidney Dis. 2004;43(5):825-35.

Hakim R, Himmelfarb J. Hemodialysis access failure: a call to action. Kidney Int. 1998;54(4):1029-40.

Feldman HI, Kobrin S, Wasserstein A. Hemodialysis vascular access morbidity. J Am Soc. Nephrol. 1996; 7:523-35.

Ascher E, Gade P, Hingorani A, Mazzariol F, Gunduz Y, Fodera M, et al. Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations. J Vasc Surg. 2000;31(1 Pt 1):84-92.

Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 2002;62(4):1109-24.

Dixon BS, Novak L, Fangman J. Hemodialysis vascular access survival: upper-arm native arteriovenous fistula. Am J Kidney Dis. 2002;39(1):92-101.

AƱel RL, Yevzlin AS. Vascular access and patient outcomes in hemodialysis: questions answered in recent literature. Artificial organs. 2003;27(3):237-41.

Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in US hemodialysis patients. Kidney Int. 2001;60(4):1443-51.

Woods JD, Port FK. The impact of vascular access for haemodialysis on patient morbidity and mortality. Nephrol Dial Transplant. 1997;12(4):657-9.

Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. JASN. 2004;15(2):477-86.

Perera GB, Mueller MP, Kubaska SM, Wilson SE, Lawrence PF, Fujitani RM. Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg. 2004;18(1):66-73.

Fitzgerald JT, Schanzer A, McVicar JP, Chin AI, Perez RV, Troppmann C. Upper arm arteriovenous fistula versus forearm looped arteriovenous graft for hemodialysis access: a comparative analysis. Ann Vasc Surg. 2005;19(6):843-50.

Keuter XH, De Smet AA, Kessels AG, van der Sande FM, Rob JT, Tordoir JH. A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg. 2008;47(2):395-401.

Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int. 2002;61(1):305-16.

Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg. 2003;38(5):1005-11.

Lee T, Barker J, Allon M. Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula. J Am Soc. Nephrol. 2007;18(6):1936-41.

Patel A, Dalal A, Ajay M. Study of 110 cases of arteriovenous fistula created for hemodialysis. Ind J App Bas Med Sci. 2006;8(1).

Son HJ, Min SK, Min SI, Park YJ, Ha J, Kim SJ. Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula. J Vasc Surg. 2010;51(3):667-72.

Beathard GA. Creating an arteriovenous fistula for hemodialysis. UpToDate. 2014.

Saran R, Pisoni RL, Young EW. Timing of first cannulation of arteriovenous fistula: are we waiting too long? Nephrol Dial Transplant. 2005;20(4):688-90.

Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, et al. Hemodialysis Arteriovenous Fistula Maturity: US Evaluation 1. Radiology. 2002;225(1):59-64.

Petrovic D. Clinical importance of color doppler ultrasonography in preoperative assesment of hemodialysis vascular access creation. Anamed. 2012;7(2):113-8.

Beathard GA, Berns JS, Eidt JF, Mills Sr JL, Collins KA. Maturation and evaluation of the newly created hemodialysis arteriovenous fistula. Available at: http://www.uptodate.com/ contents/ maturation-and-evaluation-of-the-newly-created-hemodialysis-arteriovenous-fistula

Hammes M. Hemodialysis Access: The Fistula, Technical Problems in Patients on Hemodialysis, Prof. Maria Goretti Penido (Ed.). 2011. ISBN: 978-953-307-403-0.

Beathard GA, Arnold P, Jackson J, Litchfield T. Aggressive treatment of early fistula failure. Kidney Int. 2003;64(4):1487-94.

Mahakalkar CC, Kolte SP, Yeola ME, Patwardhan MA, Jain NN, Kaple MN. Site selection for vascular access creation in hemodialysis in end stage renal disease. Int J Res Med Sci. 2014;2(2):681-5.