The brachiocephalic fistula: a successful secondary vascular access procedure

In the period from January 1988 to July 1989, 185 arteriovenous conduits for hemodialysis were created in 150 patients with end stage renal disease including 20 procedures (13 patients) performed as emergency external shunts. Of the remaining patients 125/137 (139 procedures) could be followed. The procedures included 85 end-to-side radiocephalic wrist fistulas, 42 end-to-side brachiocephalic elbow fistulas and 12 brachioaxillary grafts. Complications associated with brachiocephalic fistulas were not significantly higher than with radiocephalic fistulas, except for the development of arterial steal and pseudoaneurysm formation. The 12-month patency rates were 72% and 75% in radiocephalic and brachiocephalic fistulas respectively. The end-to-side brachiocephalic fistula is a successful secondary vascular access procedure and is recommended when a primary radiocephalic fistula fails.