Comparison of Radiocephalic and Brachiocephalic Arteriovenous Fistulas for Vascular Access in End-Stage Renal Disease Patients

Background: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis in end-stage renal disease (ESRD) patients. While radiocephalic (RC) and brachiocephalic (BC) AVFs are commonly used, their comparative efficacy remains debated. This study aimed to compare RC and BC AVFs outcomes in ESRD patients. Methods: A comparative observational study was conducted from January 2019 to December 2021, including 83 ESRD patients who underwent RC or BC AVF creation in the Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Demographic, clinical, and surgical data were collected. Outcomes included primary patency, maturation time, complication rates, and access usability for dialysis. Data were analyzed using SPSS version 23.0, with categorical variables compared via Chi-square tests and continuous variables via ttests/Mann-Whitney U tests. Results: This prospective study compared outcomes between 45 radiocephalic (RC) and 38 brachiocephalic (BC) arteriovenous fistulas. BC fistulas demonstrated significantly better performance, with shorter mean maturation time (4.2 vs 6.5 weeks, p<0.001), higher 6-month primary patency (82.1% vs 65.3%), and lower thrombosis rates (10.5% vs 22.2%). However, BC fistulas had a 7.9% incidence of steal syndrome, while RC fistulas showed higher stenosis rates (28.9% vs 15.8%) and required more secondary interventions. Conclusion: BC fistulas provide superior outcomes but require monitoring for steal syndrome. RC fistulas remain important for access preservation despite higher failure rates. Individualized selection based on vascular anatomy and patient factors is crucial for optimal vascular access outcomes in hemodialysis patients. Keywords: Arteriovenous fistula, Brachiocephalic, ESRD, Hemodialysis access, Radiocephalic