Hemodialysis international. International Symposium on Home Hemodialysis · 2026
Long Term Outcome of Brachial-Basilic Arteriovenous Fistulas.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shrestha Kajan Raj, Kadel Prashiddha Bikram, Pradhan Rajat, Shrestha Uttam Krishna
Аннотация
INTRODUCTION: Autogenous arteriovenous fistulas are the preferred vascular access for hemodialysis due to superior patency and lower infection rates compared with grafts or catheters. The brachiobasilic AV fistula provides a valuable option for patients with unsuitable veins, though it remains underutilized due to technical challenges and wound morbidity. This study aimed to evaluate the clinical outcomes, patency, and complications of brachiobasilic-AV fistula creation over a 10-year period at a tertiary vascular center.
METHODS: A retrospective descriptive analysis was conducted of all patients who underwent brachiobasilic AV fistula creation between January 2014 and December 2024 at the Manmohan Cardiothoracic Vascular and Transplant Center. Demographics, comorbidities, operative details, and outcomes were obtained from hospital records and follow-up interviews. Preoperative vessel diameters were assessed using Doppler ultrasonography. Brachiobasilic AV fistulas were created using either single-stage (82.6%) or two-stage (17.4%) techniques. Statistical analysis was performed to assess maturation, patency, and complication rates (p < 0.05 considered significant).
RESULTS: A total of 167 brachiobasilic AV fistulas were created in 158 patients (62 males, 96 females; mean age 55.6 ± 15.8 years). The most common comorbidities were hypertension (91.1%) and diabetes (49.4%). The mean basilic vein and brachial artery diameters were 3.46 ± 1.6 mm and 3.23 ± 0.8 mm, respectively. Successful maturation occurred in 141 cases (84.4%) within 6 weeks, while 21 (12.6%) experienced early failure. Primary patency was 22 ± 5 months, and secondary patency was 6 ± 2.1 months. Kaplan-Meier analysis demonstrated primary patency rates of 98%, 65%, and 28% at 1, 3, and 5 years, respectively. The most frequent complications included bleeding (40.7%), infection (12.6%), and pseudoaneurysm (11.4%).
CONCLUSION: For the patients with exhausted autogenous vascular access, brachiobasilic AV fistula is a viable procedure in our setting with acceptable complication and patency outcomes comparable to international standards. Outcome and postoperative complication can be reduced by adoption of newer techniques which need further evaluation considering cost and benefit issue.
METHODS: A retrospective descriptive analysis was conducted of all patients who underwent brachiobasilic AV fistula creation between January 2014 and December 2024 at the Manmohan Cardiothoracic Vascular and Transplant Center. Demographics, comorbidities, operative details, and outcomes were obtained from hospital records and follow-up interviews. Preoperative vessel diameters were assessed using Doppler ultrasonography. Brachiobasilic AV fistulas were created using either single-stage (82.6%) or two-stage (17.4%) techniques. Statistical analysis was performed to assess maturation, patency, and complication rates (p < 0.05 considered significant).
RESULTS: A total of 167 brachiobasilic AV fistulas were created in 158 patients (62 males, 96 females; mean age 55.6 ± 15.8 years). The most common comorbidities were hypertension (91.1%) and diabetes (49.4%). The mean basilic vein and brachial artery diameters were 3.46 ± 1.6 mm and 3.23 ± 0.8 mm, respectively. Successful maturation occurred in 141 cases (84.4%) within 6 weeks, while 21 (12.6%) experienced early failure. Primary patency was 22 ± 5 months, and secondary patency was 6 ± 2.1 months. Kaplan-Meier analysis demonstrated primary patency rates of 98%, 65%, and 28% at 1, 3, and 5 years, respectively. The most frequent complications included bleeding (40.7%), infection (12.6%), and pseudoaneurysm (11.4%).
CONCLUSION: For the patients with exhausted autogenous vascular access, brachiobasilic AV fistula is a viable procedure in our setting with acceptable complication and patency outcomes comparable to international standards. Outcome and postoperative complication can be reduced by adoption of newer techniques which need further evaluation considering cost and benefit issue.