Characteristic differences in cephalic arch geometry for diabetic and non-diabetic ESRD patients

Abstract

Fistula access in chronic haemodialysis patients is recommended. The first and second choice for location of fistula placement is radial-cephalic followed by the brachiocephalic fistula. Fistula access using the cephalic vein often results in cephalic arch stenosis that is less common in diabetics for unclear reasons. The objective of the current study is to determine if geometry of the cephalic arch differs between diabetics and non-diabetics. In a retrospective design, 57 patients with brachiocephalic fistula access had radiology films of the cephalic arch reviewed for geometric analysis. Twelve patients were excluded from final analysis because of stent placement in the cephalic arch. Measurements made included diameter of the cephalic vein, minimum radius of curvature and angle of the arch. Demographics were statistically analysed to determine the association with the geometric measurements. Global and local measurements showed evidence of two arch types. Wider arch angles and larger R/d were associated with diabetes by univariate (P < 0.05) and multivariate analyses (P < 0.05). A wider arch angle was also associated with a history of right permcath access by multivariable analysis (P = 0.042). Based on this study, it was found that there are two distinct types of cephalic arch geometries. Patients having diabetes mellitus show a significant probability of having a larger R/d ratio and wider arch angle. This study has given insight into structural alterations in geometry of the cephalic arch of diabetics with brachiocephalic fistula access.