Which type of AV fistula is best for dialysis patients?

Once kidney function goes below 10-15% of normal function, the blood fills with toxins and fluids, endangering the life of the patient. In order to sustain life, dialysis treatments or a kidney transplant become crucial. The dialysis treatment replaces the kidney’s function by cleaning the blood from toxins and draining excess fluids from the body.

During dialysis (also known as hemodialysis) the blood is removed from the body and placed through a filter. Toxins, such as urea, potassium and creatinine are removed, and the cleaned blood is returned to the body. Dialysis is a long process requiring 3-5 hours, 3 times a week. Gaining safe and easy access to the blood system is necessary for dialysis, and is obtained by one of three methods: catheter, arteriovenous (AV) graft and arteriovenous (AV) fistula.

 

Benefits of AV fistula for dialysis

Use of the arteriovenous (AV) fistula for dialysis is considered by far to be the best option. In comparison to other types of access, the AVF dialysis has lower complication rates, is less prone to infection or blood clotting and allows for a greater blood flow. The AV fistula for dialysis is considered to be less expensive to maintain, and with a longer life-span.  To date, over 66% of continued patients and more than 50% of all new patients on dialysis use a fistula.

Types of AV fistula for dialysis

There are 3 basic types of AVF dialysis:

• Radial Cephalic fistula
• Brachial Cephalic
• Brachial Basilic Transposition

All AVF for dialysis possess similar traits and characteristics. They are all created from native vessels, with no usage of synthetic materials in the body. The surgical process is relatively simple and quick. All AVF fistulas require a maturation time in order to allow for an increase and thickening of vessel walls.

The Radial Cephalic Fistula is the hardest to create. The surgery is vein to artery anastomosis, connecting the radial artery and the cephalic vein. The radial cephalic has a lower blood flow than the other two types, but preserves upper arm vessels for later attempts, if needed. The radial cephalic arteriovenous at the wrist is the recommended first choice for hemodialysis access.

The Brachial Cephalic Fistula is created by using the upper arm cephalic vein and connecting it to the brachial artery, and since the blood vessels in this area are larger it is the easiest fistula to create. It generally requires less dissection than the brachial-basilic fistula, and is easier to cannulate, with a larger possible selection of cannulation sites. The brachial-cephalic fistula allows for higher blood flow, but also has a slightly higher incidence of steal syndrome.

The Brachial Basilic Fistula is more complex to create, and requires the vein to be elevated and transposed in order to become usable as vascular access. The connection is done between a mobilized vein from a deeper location, to a superficial tunnel. The brachial-basilic fistula is associated with more patient morbidity, but also tends to be better preserved. The shorter length makes the brachial-basilic fistula more difficult to cannulate, and has a higher incidence of steal syndrome.  This form of access is used primarily in patients who have had multiple failed access procedures previously.

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