Comparison of Efficacy and Outcome of Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients of Chronic Kidney Disease

Abstract

Introduction: Hemodialysis is the most common treatment modality for patients with End-Stage Renal Disease (ESRD). Vascular access can be created in the form of arteriovenous fistula (AVF), arteriovenous graft (AVG) or central venous catheter (CVC). Material and Methods: The study was conducted in the Department of Urology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India from November 2016 onwards on patients who were admitted with chronic kidney disease and requires venous access for haemodialysis. The study included 60 patients divided into two groups: Group 1: In whom radiocephalic fistula was made; and Group 2: In whom brachiocephalic fistula was made. Patients were followed up for three months to look for maturation, patency, flow, and complications. Results: Out of total 60 patients’ males were 38 (63.3%), and females were 22 (36.7%), with male to female ratio equal to 1.72:1. Diabetes mellitus (40%) was the most common cause of end-stage renal failure (ESRF) among patients. Mean age of presentation was 51.8±3.85 years. In our study Q_max was 614.90±50.26 and 810.47 ±48.31, depth of fistula was 5.017±0.42 mm and 4.4430.24 mm and diameter of cephalic vein was 5.36±0.49 mm and 6.63±0.50 mm in radiocephalic and brachiocephalic fistula, respectively.  The mean time for maturation was 42.83±2.78 and 36.13±2.58 days for radiocephalic and brachiocephalic fistula, respectively. Primary patency on 90th day was 96.6% in brachiocephalic fistula and 73.3% in radiocephalic fistula. Secondary failure was present in one case of brachiocephalic and eight cases of radiocephalic fistulas. Complications were pseudoaneurysm [four (6.67%)], thrombosis [three (5%)], rupture [two (3%)], infection, bleeding and wound gaping [12 (20%)] and limb edema [six (10%)]. Conclusion: Our study concluded that brachiocephalic AVF is more efficacious then radiocephalic AVF in EDRF patients as flow rate, mean depth of vessel from skin and diameter of vessel was more for brachiocephalic AVF. Brachiocephalic AVF matured earlier and has lesser secondary failure rate.

Keywords: End-stage renal failure (ESRF), arteriovenous fistula (AVF), brachiocephalic, radiocephalic

Cite this Article

Vikas Verma, Devendra Pawar, Sarita Rawat, Amit Mann. Comparison of Efficacy and Outcome of Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients of Chronic Kidney Disease. Research & Reviews: Journal of Surgery. 2019; 8(1): 6–12p.