Evaluation of the proximal radio cephalic arteriovenous fistula for hemodialysis

Abstract

Objective To evaluate the proximal radiocephalic arteriovenous fistula (pRCF) as a hemodialysis access. Background The gold standard arteriovenous fistula is the distal radiocephalic fistula at wrist. If distal vessels are not suitable, a brachiocephalic fistula is a good vascular access, but many cases were reported to have dialysis access steal syndrome, so doing pRCF is a good alternative option. Patients and methods A prospective study was conducted on 30 patients who were in need for hemodialysis access between May 2016 to November 2016 and follow-up of patients was carried out until May 2017 at Menoufia University Hospital. The data for primary success rate, primary patency, secondary patency rates, and complications were collected and analyzed. Results Thirty patients underwent pRCF. Primary fistula failure was seen in 0%, whereas six (20%) fistulas failed later, four of them owing to thrombosis, one owing to anastomotic aneurysm, and one owing to extensive edema. Two (6.7%) patients were lost (censored) to follow-up. No patients developed steal syndrome, and the incidence of it was 0%. One (3.3%) fistula showed weak flow. Primary patency rate was 63.3%, whereas secondary patency rate was 73.3%. Conclusion For patients with prior forearm arterio-venous (AV) fistula dysfunction, or inadequate wrist vessels, we believe that a proximal radiocephalic approach should precede creation of brachiocephalic fistula to avoid the risk of dialysis-associated steal syndrome.