PATENCY RATE OF BRACHIOCEPHALIC VS RADIOCEPHALIC AVF IN CHRONIC KIDNEY DISEASE PATIENTS IN POPULATION OF D.I.KHAN DIVISION, PAKISTAN

Waseem Ahmad, Saqibah Rehman, Muhammad Aamir, Dastgeer Waheed

Abstract


Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it can be retained for only 02-03weeks due to infection. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs Brachiocephalic AVFs in population of D.I.Khan division, Pakistan.

Materials & Methods: This randomized controlled trail was conducted in the surgical unit at District Headquarter Teaching Hospital D.I.Khan, Pakistan from January 2017 to January 2020. Two hundred and sixty six patients were randomly allocated by toss method into two groups, one for Brachiocephalic AVF (BCAVF) and second for Radiocephalic AVF (RCAVF). Sex & patency rates were our nominal while age grouping was our ordinal variable. The data for the sample was described by count & percentages & was analyzed for the population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare the patency rate of Brachiocephalic AVF vs. Radiocephalic AVF at alpha 0.05 with Yates continuity correction using online statistical calculator.

Results: The patency was present in 129 (97%, 80% CI 94.45-98.39%) cases & absent in 4 (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic AVF group while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases & absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p-value of <.0001 (less than alpha). So, the null hypothesis was rejected, showing significant difference between two groups.

Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint.


Keywords


Arteriovenous Fistula; Elderly, Survival; Vessel diameter; Cannulation; Hemodialysis; Radiocephalic; Brachiocephalic; Endstage renal disease; Patency; Vascular access type.

Full Text:

PDF

References


Jamil M, Usman R, Ali K. Proximal arterio venous fistula creation-a gold standard in chronic renal failure patients with multiple comorbids. J Ayub Med Coll Abbotabad 2018;30(3):439-42.

Singh M, Sankhwar S. Basilic vein transposition for multiple failed arteriovenous fistulas-our experience. Hypertension 2018;24:80. https://doi.org/10.18410/jebmh/2018/13

Harms JC, Rangarajan S, Young CJ, Barker-Finkel J, Allon M. Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use. J Vasc Surg Venous Lymphat Disord 2016;64(1):155-62. https://doi.org/10.1016/j.jvs.2016.02.033

Bylsma L, Gage S, Reichert H, Dahl S, Lawson J. Arteriovenous fistulae for haemodialysis: a systematic review and meta-analysis of efficacy and safety outcomes. Eur J Vasc Endovasc Surg 2017;54(4):513-22. https://doi.org/10.1016/j.ejvs.2017.06.024

Al-Jaishi AA, Liu AR Lok CE, Zhang JC, Moist LM. Complications of the arteriovenous fistula: a systematic review. Clin J Am Soc Nephrol 2017;28(6):1839-50. https://doi.org/10.1681/ASN.2016040412

Allon M, Robbin ML, Umphrey HR, Young CJ, Deierhoi MH, Goodman J, et al. Preoperative arterial microcalcification and clinical outcomes of arteriovenous fistulas for hemodialysis. Am J Kidney Dis 2015;66(1):84-90. https://doi.org/10.1053/j.ajkd.2014.12.015

Cheung AK, Imrey PB, Alpers CE, Robbin ML, Radeva M, Larive B, et al. Intimal hyperplasia, stenosis, and arteriovenous fistula maturation failure in the Hemodialysis Fistula Maturation Study. Clin J Am Soc Nephrol 2017;28(10):3005-13. https://doi.org/10.1681/ASN.2016121355

Allon M, Greene T, Dember LM, Vita JA, Cheung AK, Hamburg NM, et al. Association between preoperative vascular function and postoperative arteriovenous fistula development. Clin J Am Soc Nephrol 2016;27(12):3788-95. https://doi.org/10.1681/ASN.2015020141

Hicks CW, Bronsert M, Hammermeister KE, Henderson WG, Gibula DR, Black III JH, et al. Trends, determinants, and outcomes of inpatient versus outpatient arteriovenous fistula operations. Ann Vasc Surg 2018;46:65-74. e1. https://doi.org/10.1016/j.avsg.2017.07.032

McGrogan DG, Maxwell AP, Khawaja AZ, Inston NG. Current tools for prediction of arteriovenous fistula outcomes. Clin Kidney J 2015;8(3):282-9. https://doi.org/10.1093/ckj/sfv019

Kim, JJ Gifford, E Nguyen, V, Kaji AH, Chisum P, Zeng A, et al. Increased use of brachiocephalic arteriovenous fistulas improves functional primary patency. J Vasc Surg 2015;62(2):442-7. https://doi.org/10.1016/j.jvs.2015.03.019

Bae E, Lee H, Kim DK, Oh K-H, Kim YS, Ahn C, et al. Autologous arteriovenous fistula is associated with superior outcomes in elderly hemodialysis patients. BMC Nephrol 2018 Nov 6;19(1):306. https://doi.org/10.1186/s12882-018-1109-9

Miller CD, Robbin ML, Allon M. Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int 2003 Jan 1;63(1):346-52. https://doi.org/10.1046/j.1523-1755.2003.00740.x

Fitzgerald JT, Schanzer A, Chin AI, McVicar JP, Perez RV, Troppmann C. Outcomes of upper arm arteriovenous fistulas for maintenance hemodialysis access. Arch Surg 2004 Feb 1;139(2):201-8. https://doi.org/10.1001/archsurg.139.2.201

Lok CE, Oliver MJ, Su J, Bhola C, Hannigan N, Jassal SV. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int 2005 Jun 1;67(6):2462-9. https://doi.org/10.1111/j.1523-1755.2005.00355.x

Weale AR, Bevis P, Neary WD, Boyes S, Morgan JD, Lear PA, et al . Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly. J Vas Sur 2008 Jan 1;47(1):144-50. https://doi.org/10.1016/j.jvs.2007.09.046

Magar D, Shrestha K, Chapagain D Shrestha K, Thapa S. Study of autologous radiocephalic and brachiocephalic arteriovenous fistula in patients with end stage renal disease. J Nepalgunj Med Coll 2020 Dec 31;18(1):78-81. https://doi.org/10.3126/jngmc.v18i1.35206

Mishra B. Comparison of distal radiocephalic fistula vs proximal radiocephalic fistula. J Family Med Prim Care 2021 Jan;10(1):132. https://doi.org/10.4103/jfmpc.jfmpc_1232_20

Statistics Kingdom. Proportion confidence interval calculator [internet]. Statistics Kingdom; Melbourne, Australia 2007. [accessed 2020 Jan 2]. Available at: http://www.statskingdom.com/41_proportion_confidence_interval.html

Motulsky HJ. GraphPad, QuickCalcs. McNemar's test to analyze experimental studies [accessed 2020 Jan 2]. GraphPad Software, San Diego, CA, USA. Available at: https://www.graphpad.com/quickcalcs/McNemar1.cfm

Marwat M, Ahmad I, Ashiq F, Ali S, Zamir S, Rehman MU, et al. Frequency, distribution and determinants of diabetes mellitus in adult acute coronary syndrome population of D.I.Khan Division, Pakistan. Gomal J Med Sci 2019 Oct-Dec; 17 (4): 131-43. https://doi.org/10.46903/gjms/17.04.2106

Ain N, Khan S, Marwat M, Khan N, Ahmad I, Ramzan F, et al. Frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Gomal J Med Sci 2019 Jul-Sep; 17 (3):81-9. https://doi.org/10.46903/gjms/17.03.2076

Zar JH. Biostatistical Analysis. 5th ed. Englewood Clifts, New Jersey: Prentice-Hall, Inc. p.127.

Pegano M, Gauvreau K. Principals of Biostatistics. 2nd ed. Boston, MA, USA: Cengage Learning; 2000. p.349-52.

Shah HU, Gul H, Khan R, Marwat M. Urethrocutaneous fistula following Snodgrass versus two stage Aivar Bracka repair of distal penile hypospadias in male children: a randomized control trial. Gomal J Med Sci 2018;16:54-8. https://doi.org/10.46903/gjms/16.02.1284

Butt M, Rehman MU, Khan AR, Abrar A. Frequency of triple-vessel coronary artery disease in adult type 2 diabetics versus non-diabetics in coronary artery disease population of Islamabad, Pakistan. Gomal J Med Sci 2019 Apr-Jun;17(2):37-41. https://doi.org/10.46903/gjms/17.02.2029

Vandecasteele, Steefan J, Tamura MK. A patient centered vision of care for ESRD: Dialysis as a bridging treatment or as a final destination? J Am Soc Nephrol 2014 Aug 1;25(8):1647-51. https://doi.org/10.1681/ASN.2013101082

Allon M. Current management of vascular access. Clin J Am Soc Nephrol 2007 Jul 1;2 (4):786-800. https://doi.org/10.2215/CJN.00860207




DOI: https://doi.org/10.46903/gjms/20.01.1094

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022. Waseem Ahmad, Saqibah Rehman, Muhammad Aamir, Dastgeer Waheed

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Gomal Medical College, Daraban Road, Dera Ismail Khan, Pakistan

ISSN: 1819-7973, e-ISSN: 1997-2067

Website: https://www.gmcdikhan.edu.pk

Phone: +92-966-747373

Scimago Journal & Country Rank