Comparison of Primary Failure Rates for Radiocephalic, Brachiocephalic and Brachiobasilic Fistulas Between Patients of Diabetes and Non-Diabetes with Chronic Kidney Disease

Abstract

Objective: To compare primary failure rates for radiocephalic, brachiocephalic and brachiobasilic fistulas between patients with and without diabetes mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital, Peshawar Pakistan Aug 2020 to Mar 2022.Methodology: Patients with chronic kidney disease referred for arteriovenous fistula surgery were included. Groups of patients with and without diabetes were age and gender-matched. Pre-operative ultrasound mapping was used for sitting,with a 3 mm diameter outflow vein set as the minimum criterion. End-to-side anastomosis using a parachute technique was performed. Patients were followed up at two, four and six weeks after surgery to assess the functional status of fistulas clinically. Results: There were 172 patients, including 71 with diabetes mellitus. The mean age was 54.67±20.56 years. Overall, there was no difference between the two groups in rates of primary fistula failure at six weeks 9(12.67%) vs 8(7.92%), p=0.304). Brachiocephalic fistulas were made in a greater proportion of patients with diabetes as compared to those without diabetes. At six weeks, 5(10.64%) of these amongst the former were non-functional, as compared to none in the letter group (p=0.024). There was no difference in radiocephalic and brachiobasilic fistula maturity rates between the two groups at the end of the sixth postoperative week. Conclusion: Diabetes mellitus is associated with higher primary failure rates in brachiocephalic fistulas, but the outcomes are the same for radiocephalic and brachiobasilic fistulas as compared to patients without diabetes.