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Home > Vascular Annual Meeting > koksoy_brachiobasilic_brachiocephalic

Brachiobasilic vs. Brachiocephalic Arteriovenous Fistula: A Randomized Prospective Analysis of 100 Cases

Cuneyt Koksoy, Rojbin Karakoyun Demirci, Deniz Balci, Tuba Solak.
Ankara University Department of General Surgery Division of Vascular Surgery, Ankara, Turkey.

OBJECTIVES: Currently; brachiocephalic (BC) arteriovenous fistula (AVF) is preferred over brachiobasilic (BB) fistula however there is limited prospective data comparing technical and clinical outcomes of these two approaches. In this study we aimed to compare the outcomes of BC and BB AVF.

METHODS: Between January 2003 - January 2007 100 dialysis patients (61male, 39 female) who have lost more distal AVF’s were randomized into BC and BB AVF groups, After preoperative dublex mapping; patients with patent basilic or cephalic veins greater than 3 mm of diameter were randomized, each group consisting 50 patients. Follow-up data were prospectively collected and patients were controlled with doppler USG in the postop day 1, after the first dialysis and every three months thereafter.

RESULTS: Baseline demographics and preoperative history of smoking, hypertension and diabetes were comparable among groups. All patients tolerated the procedures well, with intravenous sedation and local anesthesia. The mean duration of operation was significantly higher in BB group (86,5±30,18 vs. 45.0±14,87 p<0.01). There were no early thrombosis and 18 late thrombosis (12 BC group, 6 BB group). There were no statistically significant difference in terms of early (thrombosis, hemorrhage, infections) or late complications (thrombosis, failure of maturation, aneurysm) between groups. With an estimated mean follow-up of 36 months, Kaplan Meier analysis showed that the primary patency rate of BBF were slightly higher which did not reach significance (p=0.17) [Figure 1]. Secondary patency rates were also found to be not significant between groups (p=0.09) [Figure 2]. During the study period there were 25 deaths (15 BC group, 10 BB group), all with a functioning AVF.

CONCLUSIONS: Our results indicate that BB AVF is an equally effective and safe alternative to BC AVF. While there is less late thrombosis with BB AVF, the duration of the operations being significantly higher should also be considered.

AUTHOR DISCLOSURES: C. Koksoy, None; R.K. Demirci, None; D. Balci, None; T. Solak, None.