Brachio-Cephalic AVF as a Preferred Autogenous Hemodialysis Access in Elderly Chronic Kidney Disease Patients

Objective: To identify the preferred method of primary autogenous hemodialysis vascular access in elderly patients with End Stage Kidney Disease. Study Design: Prospective comparative study Place and Duration of Study: Department of vascular surgery, Combined Military Hospital, Rawalpindi Pakistan, from June 2020 to May 2021. Methodology: Outcomes of the patients with Radiocephalic (RCAVF) and Brachiocephalic (BCAVF) Arteriovenous fistula were analyzed, undergoing a first surgical vascular access procedure for hemodialysis (HD). We examined the effect of age and other factors including sex, diabetes mellitus and preoperative duplex ultrasound imaging on AVF maturity and primary patency. Results: We recruited 460 patients who underwent Radiocephalic (RCAVF) and Brachio-Cephalic AVF (BCAVF) primary HD vascular access procedure. The mean maturity time in RCAVF group was 8.30±2.3 weeks while in the BCAVF group was 4.60±2.2 weeks and result was statistically significant (p<0.001). Primary Patency at 6 months was 59.9% in RCAVF group while 85.7% in the BCAVF group, the chi square test result showed statistical significance (<0.001). Likewise mean Operative Time in RCAVF group was 70.26±1.48 minutes while in the BCAVF group was 50.01±1.52 minutes and the result of independent sample t test showed statistical significance. Patient survival in our study was 86.0% at 12 months. Conclusion: Brachiocephalic AVFs is feasible choice, as hemodialysis vascular access in Elderly CKD patients in terms of Maturity, Primary patency and mean operative time as compared to forearm Radiocephalic AVFs.