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Updated: Jun 16, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Dual outflow upper arm arteriovenous fistula: An effective technique to prevent cephalic arch stenosis
Hong Pil Hwang1,2, Hee Chul Yu1,2, Jae Do Yang1,2
1Department of Surgery, Jeonbuk National University Medical School, Jeonju, South Korea.
Insights
Dual outflow arteriovenous fistulas (AVFs) using cephalic and basilic veins significantly reduce cephalic arch stenosis (CAS) and fistula occlusion compared to traditional brachio-cephalic AVFs (BCAVF). This surgical approach offers improved secondary patency rates for hemodialysis patients.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Cephalic arch stenosis (CAS) is a common complication impacting arteriovenous fistula (AVF) functionality in hemodialysis patients.
- Brachio-cephalic AVFs (BCAVF) are susceptible to CAS, necessitating strategies to improve long-term patency.
Purpose of the Study:
- To evaluate the effectiveness of dual outflow AVF creation, utilizing both cephalic and basilic veins, in preventing CAS.
- To compare the incidence of CAS, fistula occlusion, and patency rates between brachio-cephalic-basilic AVF (BCBAVF) and traditional BCAVF.
Main Methods:
- A retrospective study of 251 patients undergoing upper arm AVF creation between July 2016 and December 2019.
- Patients were divided into two groups: 207 undergoing BCAVF and 44 undergoing BCBAVF.
- Outcomes including CAS, fistula occlusion, and primary, primary-assisted, and secondary patency rates at 12 months were analyzed.
Main Results:
- CAS occurred significantly less frequently in the BCBAVF group (9.1%) compared to the BCAVF group (30.4%).
- Fistula occlusion was also lower in the BCBAVF group (4.5% vs. 15.9%).
- While primary and primary-assisted patency showed a trend favoring BCBAVF, secondary patency rates at 12 months were significantly higher for BCBAVF (93.2%) versus BCAVF (92.2%).
Conclusions:
- Upper arm AVF with dual cephalic and basilic vein outflow is an effective surgical method for preventing CAS.
- This dual outflow approach offers superior secondary patency rates compared to traditional BCAVF, making it an optimal choice for hemodialysis access.
Abstract:
Cephalic arch stenosis (CAS) is critical point to maintain functional arteriovenous fistula (AVF) in patients undergoing hemodialysis with brachio-cephalic AVFs. In this study, we aimed to determine the effectiveness of dual outflow (cephalic and basilic veins) as a surgical method to prevent CAS. Between July 2016 and December 2019, 369 patients underwent upper arm AVF creation. Among them the 251 patients were enrolled in this retrospective study. Two hundred seven underwent brachio-cephalic arteriovenous fistula (BCAVF) and 44 underwent brachio-cephalicbasilic arteriovenous fistula (BCBAVF). From the 251 patients, diabetes mellitus (66.7% vs 36.4%, P < .001) and hypertension (91.3% vs 75%, P = .002) were more common in the patient group who underwent BCAVF surgery; however, the difference in volume flow to the fistula did not differ between the 2 groups. CAS (30.4% vs 9.1%, P = .004) and fistula occlusion (15.9% vs 4.5%, P = .048) were likely to occur in the BCAVF group. The primary patency rates at 12 months were 74.3% and 86.4% for the BCAVFs and BCBAVFs, respectively (P = .075). The primary-assisted patency rates at 12 months were 87.0% for BCAVFs and 93.2% for BCBAVFs, respectively (P = .145). Secondary patency rates at 12 months were 92.2% for BCAVFs and 93.2% for BCBAVFs, respectively (P = .023). Compared to BCAVF, traditional upper arm AVF, upper arm AVF with cephalic and basilic vein dual drainage can be optimal surgical method to preventing CAS.
