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Vascular access: experience with the brachiocephalic fistula
Annals of the Royal College of Surgeons of England
|July 1, 1986
Summary
The end-to-side brachiocephalic fistula offers reliable secondary vascular access, demonstrating good patency rates. This technique is recommended over side-to-side for its simplicity and preservation of veins for future procedures.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Secondary vascular access is crucial for hemodialysis patients requiring long-term treatment.
- Brachiocephalic fistulae are an option for secondary access when other options fail or are unsuitable.
Purpose of the Study:
- To report an eight-year experience with brachiocephalic fistulae for vascular access.
- To compare the outcomes of end-to-side versus side-to-side brachiocephalic fistula configurations.
- To evaluate the efficacy and complications of brachiocephalic fistulae as a secondary access procedure.
Main Methods:
- Retrospective analysis of 81 brachiocephalic fistulae created in 77 patients over eight years.
- Categorization of fistulae into end-to-side (n=41) and side-to-side (n=40) anastomotic techniques.
- Assessment of fistula patency, complications, and patient survival.
Main Results:
- Overall fistula patency was 70% at 1 year, 57% at 2 years, and 50% at 3 years.
- Anastomotic configuration did not significantly impact fistula survival.
- Cardiac failure and arterial steal syndrome were more frequent with side-to-side fistulae.
- Infection was rare, but two deaths occurred due to fistula complications.
Conclusions:
- The end-to-side brachiocephalic fistula is a recommended secondary vascular access procedure.
- This technique is simple, reliable, avoids graft use, and preserves saphenous veins for potential tertiary access.
- Careful patient selection and monitoring are essential to mitigate risks like cardiac failure.