Native Radiocephalic Arteriovenous Fistula Creation in Al – Hussein Teaching Hospital ( 2013-2019 ): Review of 50 cases

Abstract

Objective : To present the advantages of native radio-cephalic AVF creation over native brachio-cephalic AVF creation in patients with chronic renal failure and on regular hemo – dialysis. Patients : This is a retrospective study of 50 patients for whom native radio-cephalic AVF was created  in the upper limb under local anesthesia over a period of about seven years ( from 1st of March 2013 till 1st of February 2019 ). Methods: The case sheets of relevant patients for whom an AVF was created  were reviewed to collect information like patient's sex, age,  site of AVF,  type of anastomosis, etc… Results : Native radio-cephalic AVF creation was offered for different age groups and for both sexes. Side to side anastomosis was carried out for most patients and the preferred site was just above the wrist joint on the lateral aspect of forearm between the radial artery and a nearby superficial vein which was mostly the cephalic vein or one of it's tributaries. The time of first cannulation after AVF creation was variable depending on several factors. Different complications but no mortality  had been recorded perioperatively.   Conclusions : Native radio-cephalic AVF creation is always preferred over native brachio-cephalic AVF creation and every effort was made to search for a suitable distally located superficial vein for the purpose of AVF creation. The region just above the wrist joint on the lateral aspect of forearm was a suitable site for patients with CKD and those with comorbidities because the proximal locations of AVF creation are associated with more complications than the distal ones. Side to side anastomosis for AVF creation was the procedure of choice and the priority was for the non dominant upper limb if possible.