Comparing the outcomes of proximal radial artery arteriovenous fistula and brachio-cephalic arteriovenous fistula for hemodialysis vascular access

Autogenous arteriovenous fistulas (AVFs) are the recommended type of vascular access for hemodialysis (HD). Nonetheless, the precise outcome of Proximal Radial Artery Arteriovenous (PRAAVF), as well as its risk of failure and complication, has yet to be determined.

In the current single-center, by retrospective analysis of prospectively collected data, we compared the outcome of Brachial Artery AVF (BAAVF) and Proximal Radial Artery Arteriovenous (PRAAVF) in end-stage renal disease (ESRD) patients who were referred to our center between 2010 to 2018. The outcome of the fistula was routinely assessed for all patients at least two years after the surgery. All data were analyzed in SPSS software (version 16). The success rate for each procedure was reported as a percentage. The Chi-square test was used to compare the success rate between the groups.

A total of 146 patients (86 males, and 60 females) with a mean age of 55.79±17.03 years were included in the study. The results demonstrated that men and women did not significantly differ in the success rate of PRAAVF (P=0.076). The PRAAVF showed a significantly higher success rate in the 30-39 age range (P=0.03). The success rate of BCAVF did not display a significant difference between different age and gender groups (P> 0.05 for both). The success rate of PRAAVF was lower in both diabetic patients and smokers, as compared to that in healthy individuals (P=0.032 and P=0.001, respectively). None of the patients who underwent PRAAVF implementation had steal syndrome (as compared to the 2.8% rate of steal syndrome following BAAVF implementation)

As evidenced by the obtained results, PRAAVFs, which are associated with a very low risk of ischemic steal syndrome, can be regarded as safe and suitable vascular access. Accordingly, when it is anatomically feasible, PRAAVFs should be preferred over BAAVFs due to their superior clinical outcomes.