Comparative study between superficial and deep cephalic vein of mature brachiocephalic arteriovenous fistula regarding easy needling and complications

Objective
An accessible vascular access is of utmost importance for patients on hemodialysis. National Kidney Foundation Dialysis Outcome Quality Initiative has defined a criterion for a good functioning arteriovenous fistula (AVF) (Rule of 6). The purpose of this study was to evaluate the effect of depth of cephalic vein in mature brachiocephalic AVF regarding easy needling and puncture complications.
Patients and methods
A prospective cohort study was conducted on adult patients with end-stage renal disease with mature brachiocephalic AVF after fulfilling the inclusion and exclusion criteria over a 6-month follow-up period after creation of the access. They were allocated nonrandomly into two groups (superficial and deep mature cephalic vein with a cutoff value of 6 mm).
Results
During the study period, 50 patients were divided into two groups (A and B), with 25 patients in each group. Group A included 18 males and seven females, whereas group B included five males and 20 females. The mean age of patients in group A was 43.16±11.61 years, whereas in group B was 47.32±9.81 years. Diabetic patients represented 44% in both groups, whereas hypertensive patients represented 60 and 68% in groups A and B, respectively. No patients in group A experienced coronary artery disease, whereas only 4% in group B experienced coronary artery disease. Approximately 10% had history of previous AVF in both groups. Mean BMI in group A was 23.23±2.05, whereas in group B was 28.49±1.39, denoting that all patients in group B were overweight (<0.01). There was a significant difference between two groups regarding depth all over the observation period (<0.01), with no significant difference between the two groups regarding diameter and flow velocity. During follow-up, we found that there was a highly significant difference in complications in both groups during the dialysis procedure, being more in group B (<0.01).
Conclusions
Deep-seated mature cephalic vein (>6 mm depth) is highly associated with overweight patients, with more liability of complications such as hematoma and needling difficulties than superficial one, suggesting the beneficial outcomes of vein superficialization whether one-staged or two-staged procedure for further large randomized studies.