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Brachio-cephalic arteriovenous fistula: a successful alternative vascular access in chronic hemodialysis patients

Objective To compare the patency and complications between branchio cephalic(B C) arteriovenous fistulas and forearm loops Polytetrafluorothylene(PTFE) grafts. Methods In the period between Oct 1997 to Oct 2000, 35 B C fistulas and 36 PTFE grafts were constructed in 34 and 29 patients respectively after failure of primary radial cephalic fistulas. Kaplan meier survival curves were calculated to determine the cumulative patency. Results The 1, 2, 3 years cumulative patency rates of B C fistulas and PTFE grafts were 96.43% vs 54.23%, 96.43% vs 39.19%, 48.22% vs 39.19% respectively, which were much higher in the former group( P 0.01), while the total number of complications and the number of loss of function were much higher in the latter group( P 0.01). Those complications occurred in PTFE graft group included thrombosis, infection, graft exposure, pseudoaneurysm formation and seroma, among which thrombosis was most common. Surgical interventions were indispensable for all these complications. Conclusion In case primary radial cephalic fistula fails, the end to side B C fistula is a cost effective second choice of vascular access procedure and which is more preferable compared with forearm loops PTFE graft.