A Single Center Study of Clinical Success in Radiocephalic Fistula Creation

Abstract

To compare standard methods (control) with a new protocol for radiocephalic fistula (RCF) creation involving ultrasound vein mapping by the surgeon in the operating room, ligation of cephalic vein branches in the lower forearm, and use of a tourniquet for the arteriovenous anastomosis. This is a retrospective cohort study of patients who underwent radiocephalic fistula creation between April 2008 and March 2010 in a regional vascular center. Patients were identified retrospectively by reviewing hospital operating room and office billing records. The electronic charts of all patients were reviewed. The primary endpoint was functional RCF patency at last follow-up. A total of 118 patients underwent arteriovenous (AV) fistula creation by 3 surgeons during the two-year study period. Of these, 59 patients underwent RCF creation, 33 of whom were managed using the new protocol. The two groups were comparable, except for age (66 in the study group vs. 60 in the control group, P=.04). Tourniquet use shortened operative time from 48 to 36 minutes (P=.04). Functional patency was 82% vs 77% (P=.64). The new protocol for RCF creation results in shorter operative times and high functional patency rates.