Comparative study between transposed brachiobasilic and synthetic graft brachioaxillary arteriovenous fistula in patients with chronic renal failure

الملخص EN

ackground: The long-term survival and quality of life ofpatients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access.

Complications of various vascular accesses in HD increase a risk of morbidity and mortality; therefore, an arteriovenous fistula (A VF) is preferable.

Transposed brachiobasilic A VF and synthetic graft brachioaxillary A VF are commonly used.

Follow up of fistulas by vein mapping and screening techniques for early detection of arteriovenous graft stenosis is essential because dysfunctions of these fistulas are common cause of recurrent hospitalizations.

Aim of work: Is to compare transposed brachiobasilic A VF and polytetrafluoroethylene synthetic graft brachioaxillary A VF for hemodialysis regarding their function and complications.

Patients and methods: SiXty-six patients (thirty five males and thirty one females) aged 23-71 years (48 ±5.9 years) with chronic renal failure for regular HD were included in the study.

They were divided into two groups each of them was thirty-three patients.

The first group was subjected to transposed brachiobasilic AVF and the other group was for polytetrafluoroethylene (PTFE) synthetic graft brachioaxillary A VF.

Patients were subjected to CBC, prothrombin time and concentration, renal function tests, blood sugar, ECG and chest X-ray for preoperative fitness.

Upper limb phlebography, to visualize basilica, axillary and proximal veins, was done for all patients.

Patients with complete exhausted all veins of the upper limbs (basilic, axillary and central veins) diagnosed by phlebography or patients with impalpable brachial arteries pulsations were excluded from the study.

Follow up of the patients were reassessed after the surgical maneuvers both clinically (palpable thrill and audible machinery murmur) and hemodynamically by Doppler study (transmitted waves through the fistula) immediately after the surgery then one month and six months later.

Fifty-nine patients only were followed after six months (31 patients with transposed brachiobasilic A VF and 28 with synthetics graft brachioaxillary A VF) because of seven deaths.

Results: In patients with transposed brachiobasilic AVF, success rate was 90% immediately and 84% one month after maneuver and was 87% and 81% respectively in patients with synthetics graft polytetrafluoroethylene (PTFE) brachioaxillary AVF.

After six months transposed brachiobasilic AVF success rate was 84% significantly higher than that of patients with synthetics graft brachioaxillary A VF (71%) p< 0.05.

Complications were recorded in 22.4% of patients with transposed brachiobasilic AVF significantly lower than those in patients with synthetics graft brachioaxillary AVF (46%) p<0.05.

The complications were thrombosis, infection, pseudoaneurysm, bleeding and insufficient distal arterial flow (steal).

Thrombosis and infection were significantly lower in patients with transposed brachiobasilic AVF (6.4% and 3.2%) than those in patients with synthetics graft brachioaxillary AVF (17.8% for each) p<0.05 for each.

Conclusion: In patients requiring long-term haemodialysis when all their superficial veins are exhausted the choice runs between transposed brachiobasilic A VF and synthetics graft brachioaxillary A VF for the vascular access.

Transposed brachiobasilic AVF carries better patency rate and less complications than synthetics graft brachioaxillary A VF.

So it can be considered the first choice for access.

Synthetics graft brachioaxillary A VF can be utilized only when the basilic vein is not patent assessed by phlebography.

Both clinical and Doppler assessment can be used in evaluation of the fistula function and complications.