Brachiocephalic And Radiocephalic Arteriovenous Fistulas In Patients With Tunneled Dialysis Catheters Have Similar Outcomes
Jeffrey J. Siracuse, M.D., Lenee M. Plauche, MD.
Boston University, Boston, MA, USA.
OBJECTIVES: Patients with tunneled dialysis catheters (TDC) have a time sensitive need for a functional alternate access due to high risk of associated morbidity. Brachiocephalic fistulas (BCF) have been reported to have higher maturation and patency compared to radiocephalic fistulas (RCF). Our goal was to assess short-term outcomes after RCF and BCF creation for patients with concurrent TDCs to see if these patients would potentially benefit more from have an initial brachiocephalic access to minimize TDC dependence.
METHODS: The Vascular Quality Initiative hemodialysis registry was analyzed from 2011-2018. Patient demographics, comorbidities, access type, and short-term outcomes including occlusion, reinterventions, and access being used for dialysis were assessed.
RESULTS: 2,359 patients with TDC underwent 1389BCFs and 970 RCFs. Average patient age was 59 years and 62.8% were male. Compared with RCF patients those with BCF were more often older, female, white, obese, non-ambulatory, have commercial insurance, diabetes, coronary artery disease, chronic obstructive pulmonary disease, be on anticoagulation, and have a cephalic diameter of > 3mm. At three months of follow-up, access was not used in 40% of BCF and 30.7% of RCF. Multivariable analysis showed BCF to be comparable to RCF for occlusion (HR 1.1, 95% 0.91 - 1.36, P=0.32), reintervention (HR 1.01, 95% CI 0.81 - 1.27, P=0.92), access being used at 3 months (OR 0.7, 95% CI.49 - 1, P=.05), and survival (OR 94, 95% CI .7 - 1.26, P = .68). 6-month freedom from occlusion, and reintervention for BCF vs. RCF was 57.5% vs. 57.7% (P = .88), and 60.7% vs. 60.5% (P=.44), respectively. Survival at 3 years was 82% vs. 85% (P=.016).
CONCLUSIONS: BCFs do not have superior outcomes to RCFs in patients with concurrent TDCs. Creation of radial access when possible should not unnecessarily prolong tunneled line dependence.
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