A Comparative Study between Radiocephalic and Brachiocephalic Arteriovenous Fistula in End Stage Renal Disease

Md Nazmus Sabah, SM Parvez Ahmed, Md Saif Ullah Khan, Rakibul Hasan, Md Fidah Hossain, Manifa Naz Fatma

Background: Chronic Kidney Disease (CKD) is a major health issue all over the world. Patients
with deteriorating renal function and end-stage renal disease require vascular access for hemodialysis.
Studies suggest that Arterio-Venous fistula (AVF) constructed judiciously using autologous conduit
give the best outcome in this regard. Objective of the study was to compare the outcomes of Radio cephalic
and Brachiocephalic AVF in end stage renal disease (ESRD).
Methods: It was a quasi-experimental study carried out at the Department of Vascular Surgery,
Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The study was conducted from
June 2019 to May 2020. Patients suffering from ESRD underwent AVF creation surgery for
hemodialysis access. A total of 60 (Sixty) patients were included in this study. The patients were
divided into two groups; Group I included 30 patients who underwent Radio cephalic AVF operation
and Group II included 30 patients who had Brachiocephalic AVF operation.
Results: In Group I, (Radio cephalic AVF) 60% were male and 40% were female. On the other hand,
in Group II (Brachiocephalic AVF) 73.3% were male and 26.7% were female. Calculated volume flow
(Q max) was significantly higher in Group II compared with Group I (769.11±101.54 ml/min vs
626.37±55.81) ml/min) with the difference being statistically significant (P=0.001). Maturation
time was significantly less in Group II compared with Group I )37.78±1.93 vs 43.33±2.12 days) with
the difference between the two group being statistically significant (P=0.001). Complication was
more in Group I than Group II (16.7% vs 3.3%).
Conclusion: The present study shows that Brachiocephalic AVF gives significantly better outcome
in terms of shorter maturation time and less complications compared with Radio-Cephalic AVF.
Color Doppler study is an essential tool for preoperative vessel evaluation which guides the selection
of suitable AVF construction site