A Prospective Comparison of Outcomes of Brachiocephalic Versus Brachiobasilic Fistulas for Hemodialysis

Abstract

Brachiocephalic fistula (BCF) and brachiobasilic fistula (BBF) are autogenous fistulas created in the arm for hemodialysis access. However, despite the differences in anatomy and surgical technique, the existing literature shows no significant statistical difference between the maturation, patency, or complications. We analyzed the outcomes of these two types of arteriovenous fistulas in our subgroup of the Indian population. A prospective observational cohort study was performed at a tertiary hospital from August 2019 to August 2021 between patients who underwent BCF and BBF. The time to maturation, 1-year primary patency, and postoperative complications were studied. Among the 236 patients, 137 and 99 underwent BCF and BBF, respectively. 53 (39%) and 37 (37.4%) patients were lost to follow-up at the end of 12 months in each arm, respectively. Each group comprised predominantly of males. There was no significant difference in age, diabetes, coronary artery disease, or peripheral arterial disease between the groups. The time to maturation within 6 weeks, more than 6 weeks, and non-maturation was 51.88% and 58.1% (p = 0.58), 38.67% and 32.55% (p = 0.04), and 9.43% and 9.3% (p = 0.74) in BCF and BBF groups, respectively. The 1-year primary patency, primary-assisted patency, and secondary patency were 69.04% and 53.22% (p <0.001), 78.3% and 59.6%, and 79.5% and 62.9% in BCF and BBF groups, respectively. Apart from venous hypertension (BCF:2(1.5%) vs BBF:7(7.1%), p = 0.026), there were no significant differences in the postoperative complications between the groups. BCFs take longer to mature but have greater primary patency than BBF. Both of these fistulas had similar postoperative complications. Larger randomized trials are needed to confirm our findings.