Comparative study between brachiocephalic fistula and proximal radiocephalic fistula for hemodialysis in patients with end-stage renal disease

Objectives
To evaluate the proximal radiocephalic arteriovenous fistula (AVF) versus brachiocephalic fistula for hemodialysis in terms of patency and complications.
Background
The distal radiocephalic fistula at wrist is the gold standard AVF for hemodialysis as it reduces the incidence of steal syndrome but with high failure rate. If distal vessels are not suitable or exhausted, elbow fistula is a good vascular access but with increased incidence of steal syndrome, so doing proximal radiocephalic AVF is a good alternative option.
Patients and methods
A prospective randomized study including 60 patients in need for hemodialysis access was done between January 2016 and January 2017 and was followed up to July 2017 at Menoufia University Hospital. The patients were randomly categorized into two groups including 30 patients in each group. Primary success rate, primary patency, secondary patency rates, and complications of each group were collected and analyzed.
Results
In the proximal radiocephalic group, primary fistula failure was 0%, while six (20%) fistulas failed later, four of them due to thrombosis, one due to anastomotic aneurysm and the other due to severe venous hypertension. No patients developed steal syndrome, whereas in the brachiocephalic group, primary fistula failure was also 0% and six (20%) fistulas failed later on, three of them due to thrombosis, one due to anastomotic aneurysm, one due to venous hypertension, and the last one due to steal syndrome. Primary patency rates for both proximal radiocephalic and brachiocephalic groups at 6 months were 63.3 and 65.1%, respectively, whereas the secondary patency rates at 6 months were 73.3 and 75.4%, respectively.
Conclusion
For patients with exhausted or unsuitable wrist vessels, we believe that a proximal radiocephalic, should precede creation of brachiocephalic fistula as it had nearly the same patency and complications rates but it avoided the risk of dialysis associated steal syndrome.