Outcomes of brachiobasilic arteriovenous shunting with superficialization as a vascular access for renal dialysis: an early experience in Benha University

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Abstract

Purpose
The aim of the study was to assess outcomes of brachiobasilic arteriovenous fistula (BBAVF) under ultrasound (US)-guided supraclavicular block with or without superficialization and of brachiocephalic arteriovenous fistula in patients with vessels unsuitable or failed for a forearm fistula.
Patients and methods
The study included 75 patients diagnosed with end-stage renal failure. They were divided into three equal groups ( = 25) according to the site of fistula: group 1 underwent BBAVF (one-stage), group 2 underwent BBAVF (two-stage with 1-month interval), and group 3 underwent brachiocephalic arteriovenous fistula, all with end-to-side anastomosis under US-guided supraclavicular block.
Results
There was significant difference in the diameter of arm veins between the first two groups and the third group ( = 0.01), especially using supraclavicular block. Despite group 1 had the longest operative time (82.02 ± 11.39), it had the shortest duration of maturation and the best mean flow rate (ml/min) ( = 0.0004 and 0.004, respectively). The frequency of early postoperative complications - that is, primary access failure and early thrombosis (first 10 days) - and late complications - that is, late thrombosis more than 10 days and pseudoaneurysm - was less in group 1 ( = 0.05).
Conclusion
Despite one-stage BBAVF takes long operative time, it appears to be the most ideal vascular access, with high success rate, shortest duration of maturation, best mean flow rate, and less postoperative complications, and surgical redo with its complications is also less especially using US-guided supraclavicular block.

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