Purposes: The aim of the study was to assess outcomes of Brachio-Basilic Arterio-Venous fistula (BBAVF) under U/S-guided supraclavicular block with or without superficialization and of Brachio-Cephalic Arterio-Venous (BCAVF) fistula in patients with vessels unsuitable or failed for a forearm fistula.
Patients and methods: The study included 75 patients diagnosed with end-stage renal failure (ESRF). They were divided into 3 equal groups (n =25) according to the site of fistula; Group 1 underwent BBAVF (One-stage), Group 2 underwent BBAVF (Two-stage with 1month interval) & Group 3 underwent Brachio-Cephalic Arterio-Venous BCAVF; All with end to side anastmosis under U/S-guided supraclavicular block.
Results: There was significant difference in diameter of arm veins between the 1st 2 groups and the third group; (P-Value =0.01); especially using supraclavicular block. Despite; Group 1 had the longest operative time: 82.02 (+ 11.39); It had the shortest duration of maturation & the best Mean flow rate (ml/min); (P-Value =0.0004 & 0.004 respectively). The frequency of early post operative complications i.e. 1ry access failure & early thrombosis (1st 10 days) & Late complications i.e. Late thrombosis more than 10days and Pseudo-aneurysm was less in Group 1: (P-Value =0.05).
Conclusions: Despite One-stage BBAVF takes long operative time; it appears to be the most ideal vascular access; high success rate, shortest duration of maturation with the best Mean flow rate, less post-operative complications & Surgical Re-do with its complications is also less especially using U/S-guided supraclavicular block.
Key words: Arterio-venous fistula, Outcomes, Renal dialysis, Superficialization, U/S-guided supraclavicular block.
|
