The Clinical Outcomes of Using Brachial-Basilic Transposition Arteriovenous Fistula and Prosthetic Upper Arm Arteriovenous Graft as vascular access in late Stage Chronic Renal Failure

Abstract

For the end stage renal disease patients with incompetent cephalic vein arteriovenous fistula, the selection of Brachial-Basilic Transposition Arteriovenous Fistula (BBTAVF) or an upper arm arteriovenous Graft (AVG)  should be considered. This retrospective, analytic study aimed to compare the clinical outcomes and  complications of these two modalities, during July 2015 to July 2017. There were seventy-five patients  underwent a BBTAVF (27) or an upper arm AVG (48). The first successful access cannulation time for BBTAVF  (84.63 days) was longer than upper arm AVG (32.15 days) (p < 0.001). The functional primary and secondary  patency rate at 18-months follow up in both groups were 75.8% vs 65.8% (p = 0.113) and 91.7% vs 74.7% (p =  0.062), respectively. The hemodialysis catheter-related infection events after access creation were 3 (12.5%) for BBTAVF and 3 (7.0%) for upper arm AVG group (p = 0.659). The upper arm AVG group had gotten  thrombosis 10 patients (20.8%) and gotten infection 5 patients (10.4%). Conclusion, although the functional  patency and HD catheter-related infection events after access creation were not significant different but the  upper arm AVG group had more severe complications that requiring surgical interventions. Therefore  BBTAVFs should be the first choice in patients with no limited life expectancy and had no high risk on  prolonged hemodialysis catheter