Comparative Study between Different Modalities of Creation of Radiocephalic Arteriovenous Fistula Around the Wrist for Hemodialysis

Abstract

Background: It has been shown that an arteriovenous fistula [AVF] is better for hemodialysis patients than central venous catheters and arteriovenous grafts in terms of morbidity and death.Aim of the work: This study aims to compare the safety and effectiveness of the anatomical snuffbox AV fistula versus the usual radio cephalic fistula at the wrist for hemodialysis.Patients and Methods: Our study is a prospective interventional study that included 40 patients on hemodialysis scheduled for A-V fistula formation. Patients were classified into two groups; Group [A]: 20 patients who underwent standard Wrist Arterio Venous Fistula, [WAVF], and Group [B]; 20 patients who underwent AV fistula at the anatomical snuffbox [SB].Results: Clinical data, and demographics of the two groups were similar [p-value > 0.05]. After six weeks of intervention the AVF was found to be patent in 85.7% of the patients in WAVF group, and in 88.6 % of the patients in SBAVF group with no significant difference between the two groups [P value = 0.7]. In WAVF group showed one case of mild steel syndrome, and ecchymosis, and three cases of edema which resolved spontaneously. Two cases of infection responded to systemic and local management. While in the SBAVF group there was one case of ecchymosis and edema which resolved without intervention. Also, two cases of infection responded to systemic and local management.Conclusion: When a cephalic vein is anatomically inaccessible, or if a secondary surgery requires access to the wrist, the SBAVF can be used to preserve those vessels.

Keywords

• arteriovenous fistula
• hemodialysis
• radiocephalic
• snuffbox