Predictive Diameter of Cephalic Vein and Brachial Artery in Relation to Long Term Patency of Brachiocephalic Arteriovenous Fistula

Abstract

Objective: To find out the mean perianastomotic venous and arterial diameters cutoff values in relation to
long term patency of brachiocephalic access.
Material and Methods: All patients fulfilling the inclusion criteria underwent vascular mapping preoperatively
to find out mean diameter of cephalic vein and brachial artery. Kaplan-Meier survival analysis was done to
analyze the effect of vascular diameters on patency of the access and find out the predictive values. Cox regression
analysis was performed to identify the independent predictors of access failure.
Results: A total of 100 brachiocephalic accesses were analyzed with a minimal follow-up of 2 years. Mean
age was 54.2 ± SD 5.71 years with male to female ratio of 1.8:1. Advancing age (P-value: 0.001); diabetes
mellitus (P-value: 0.001), coronary artery disease (P-value: 0.000) and congestive cardiac failure (P-value:
0.001) had a strong negative association with long term patency of access. Mean brachial artery diameter less
than 4mm (SE 2.050; CI: 0.000-0.005; P value: 0.000) and mean venous diameter of cephalic vein less than 3.5mm
(SE 1.155; CI: 5.66-525.2; P value: 0.001) are strong negative predictors of patency of brachiocephalic access.
Conclusion: Mean cephalic vein of <3.5mm and brachial artery of <4mm diameters are associated with high
fistula failure rates.
Keywords: Brachiocephalic, Fistula, Diameter, Failure.