PATENCY RATE OF BRACHIOCEPHALIC VS RADIOCEPHALIC AVF IN CHRONIC KIDNEY DISEASE PATIENTS IN POPULATION OF D.I.KHAN DIVISION, PAKISTAN

Abstract

Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it can be retained for only 02-03weeks due to infection. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs Brachiocephalic AVFs in population of D.I.Khan division, Pakistan. Materials & Methods: This randomized controlled trail was conducted in the surgical unit at District Headquarter Teaching Hospital D.I.Khan, Pakistan from January 2017 to January 2020. Two hundred and sixty six patients were randomly allocated by toss method into two groups, one for Brachiocephalic AVF (BCAVF) and second for Radiocephalic AVF (RCAVF). Sex & patency rates were our nominal while age grouping was our ordinal variable. The data for the sample was described by count & percentages & was analyzed for the population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare the patency rate of Brachiocephalic AVF vs. Radiocephalic AVF at alpha 0.05 with Yates continuity correction using online statistical calculator. Results: The patency was present in 129 (97%, 80% CI 94.45-98.39%) cases & absent in 4 (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic AVF group while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases & absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p-value of <.0001 (less than alpha). So, the null hypothesis was rejected, showing significant difference between two groups. Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint.