Comparison of radiocephalic fistulas placed in the proximal forearm and in the wrist.
Non-maturation is a common problem in patients receiving an arteriovenous fistula. The first vascular access choice is a distal radiocephalic fistula (dRCF) at the wrist. Patients with a failed dRCF or with vessels unsuitable for dRCF, the recommendation is to place a brachiocephalic fistula in the upper arm. Proximal forearm radiocephalic fistulas (pRCF) are created infrequently, but may permit a second forearm fistula before proceeding to the upper arm. The goal of the present study was to compare the outcomes of them. We retrospectively analyzed a computerized access database to compare the outcomes of 19 RCF and 39 dRCF placed during a 6-month period. The baseline characteristics were similar, except those with a pRCF were more likely to have previous access and be male. Primary failure (non-maturation) was lower for pRCF than dRCF (32 vs. 59%, p = 0.05); and excluding secondary failures, cumulative fistula survival was similar (92 vs. 86% at 1 year and 74 vs. 76% at 2 years, p = 0.56). pRCF may be an attractive alternative to a brachiocephalic fistula in patients who cannot receive a dRCF. pRCF has a lower non-maturation rate than that of a dRCF, and a comparable cumulative survival once it is used successfully for dialysis.
Bhalodia
Rajeshkumar
R
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Allon
Michael
M
Hawxby
Alan M
AM
Maya
Ivan D
ID
D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D016121:Brachiocephalic Veins / Q000601:surgery*; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery*; D006435:Renal Dialysis; D012189:Retrospective Studies; D014953:Wrist / Q000098:blood supply