A COMPARISON BETWEEN BRACHIOBASILIC FISTULA AND SUPERFICIALIZATION IN ONE STAGE OR TWO STAGES

Abstract

Background: Hemodialysis continues to be the single most prevalent modality of kidney replacement therapy. Longevity on dialysis is directly proportional to the quality of dialysis, and that quality in turn depends on the reliability and integrity of the access to the patient’s vascular system. This crucial connection is known as the hemodialysis vascular access. Objective: To compare between brachiobasilic fistula and superficialization in one stage (basilic v. transposition) or two stages (basilic v. elevation) according to primary failure rate, primary patency rate, complication rate. Patients and Methods: This prospective present study was carried out at Al Azhar university hospitals, El Mokattam health insurance hospital and El Mattaria teaching hospital on 30 patients with ESRD needing vascular access in the period from January 2020 to January 2021. Results: Twelve fistulae were on the right side while eighteen patients had their fistulae on the left side. No significant difference was found. There were no significant differences between both groups in terms of the diameters of basilic vein and brachial artery among the patients. What really differs was the time to cannulate the fistula in both groups. It was earlier in Group A (p 0.007). Seroma had occurred in one patient (6.7%) in each group. Hematoma had occurred in one patient (6.7%) in Group A and two patients (13.3%) in Group B. Wound infection had occurred in one patient (6.7%) in each group. They all responded to conservative treatment. Thrombosis occurred in three patients (20%) in Group A; two patients had early thrombosis ( in the first 30 days) while one patient had thrombosis lately while two patients (13.3%) had thrombosis in Group B; one early and one late. Pseudoaneurysm occurred in only one patient in Group B (6.67%) which was impending rupture. So, it was ligated Mild steal syndrome occurred in one patient (6.67%) in each group which respond to medical treatment with no intervention. Regarding the fate of AVF, primary failure had occurred in four patients in Group A (26.7%) and in two patients in Group B (13.3%). In Group A, eleven patients (73.3%) had patent AVF after 3 months while ten patients (66.7%) had patent AVF after 6 months. In Group B, thirteen patients (86.7%) had patent AVF after 3 months while eleven patients (73.33%) had patent AVF after 6 months Conclusion: The brachiobasilic arteriovenous fistula was a good option as a native access for regular hemodialysis in chronic renal failure patients either done in one stage or in two stages with favoring two stages procedure due to higher primary patency rate and less primary failure rate.