Proximal Arteriovenous Fistulas in Hemodialysis Patients: Advantages and Disadvantages

Abstract

Introduction: The main objective of the present study is to investigate the advantages and disadvantages of proximal arteriovenous native fistulas. Hemodialysis is indispensable for patients with end-stage renal disease. For this purpose, arteriovenous fistulas (AVFs) are used. Among the native fistulas, distal radiocephalic AVF is the most preferred. However, brachiocephalic AVF (BCAVF) and brachiobasilic AVF with basilic vein transposition (basilic vein transposition arteriovenous fistula [BVTAVF]) can be used for a long time in dialysis patients whose distal vascular bed is depleted. Methods: This is a retrospective study of 117 AVFs (BCAVF and BVTAVF), in patients with end-stage chronic renal disease, that were opened with a surgical technique (2012-2018). The postoperative two-year patency rates, AVF locations, complications, and the advantages and disadvantages of these fistulas are reviewed and recorded in the light of the literature. Results: The mean age of the patients (52 men and 65 women) was 60.6 ± 13.6 years. The percentages of primary patency rates at 3, 6, 9, 12, and 24 months were 96.6%, 93.1%, 92%, 87.4%, and 82.8% in BCAVF patients, and 96.7%, 93.3%, 90%, 86.7%, and 80% in BVTAVF patients, respectively. The percentages of secondary patency rates at 6, 12, and 24 months were 100%, 93.3%, and 86.7% in BCAVF patients, and 100%, 100% and 87.7% in BVTAVF patients, respectively. Fistula thrombosis was seen as the most common complication. The early complication was bleeding/hematoma. As late complications, we encountered steal syndrome, ischemic pain in the relevant extremity, pseudoaneurysm, and high-output heart failure. Conclusion: Proximal AVFs are preferable fistulas with early maturation and high primary patency rates. We believe that relatively high complications can be avoided by opening fistulas with an appropriate surgical technique.

The association between the locations of arteriovenous fistulas and patency rates: A systematic review and meta‐analysis

“…Of the remaining 47 articles, 6 were excluded because they were not human experiments, 8 studies were deleted because they selected unsuitable inclusion criteria, 7 articles were excluded as only the upper-arm group or forearm group in their study, 12 articles were excluded as data cannot be converted or extracted in the study, and 2 was removed because they were literature reviews. Finally, a total of 12 studies [16][17][18][19][20][21][22][23][24][25][26][27] were deemed eligible for inclusion in this review (Figure 1).…”

“…17,20 The experience of the surgeon also contributes to the maturation and patency rates of the FA-AVF. 22 Therefore, specific surgical design, standardized procedures, and regular postoperative monitoring are particularly important for the patency of FA-AVF.…”

“…In the included studies, it was revealed that AVF in the forearm, especially in small vessel diameters, could be significantly improved in terms of PP and maturation rates after specific trial design and rigorous monitoring 17,20 . The experience of the surgeon also contributes to the maturation and patency rates of the FA‐AVF 22 . Therefore, specific surgical design, standardized procedures, and regular postoperative monitoring are particularly important for the patency of FA‐AVF.…”

"Fetal Anatomical Variability of the Veins of the Upper Limbs"

“…Taking into account the lower frequency of postoperative complications associated with hemodynamic changes in the basin of the radial artery and the cephalic vein used to create an arteriovenous fistula, with sufficient blood flow through the fistula itself, the optimal anastomosis is «the vein end to the artery side» 20 . Anastomosis «the vein end to the artery end» type provides the lowest speed of blood flow through the arteriovenous fistula and is therefore used when the previous type of anastomosis is impossible and exclusively in distal fistulas 21 .…”