Distal vs proximal arterio venous fistula creation in the upper limb for maintenance hemodialysis in chronic renal failure patients

Abstract

Purpose: The goal was to share our experience of the proximal and distal types of arteriovenous fistula (AVF) and to ascertain advantage of one over the other and ultimately which has a superior success rate. Methods: All patients referred to the department of CVTS, for construction of AVF underwent a detailed clinically examination to assess the quality of the venous system of the upper limb of interest. All patients with poor quality veins at the wrist or patients in whom previous AVF at the wrist had failed were taken up for proximal A-V fistula at the antecubital fossa. The surgical complications were analysed in the immediate and late postoperative period. These 230 cases were performed over a span of 12 months with regular follow up and observation for the next 12 months.Results: The proximal AVFs had only a 5.21% maturation failure cases as compared to the 13.0% in distal AVFs with mean time for maturation being 1.5 months and 2-2.5 months, respectively. The overall primary patency rates at 12 months were 98% for proximal AVFs and 74% for distal AVFs.Conclusion: The Proximal A-V fistulas for MHD were found to have early maturation and high primary patency rates in comparison to the distal AVFs which inadvertently required new proximal AVF creation in the future due to the observed complications and low maturation rates with only a palpable pulse even after 8 weeks of surgery.