A 2-year Comparative Analysis of Outcomes and Endovascular Interventions in Radio-Cephalic vs. Brachio-Cephalic Fistulae

Abstract

Background Arterio-venous fistulae are often compromised by complications, notably thrombosis. We assess the 2 year follow-up data of a cohort of patients from a single vascular centre in the UK who underwent BCF or RCF creation with the objective of assessing the outcome differences and intervention rates between fistula types. Materials and Methods We retrospectively assessed a cohort of 195 patients who underwent creation of arterio-venous fistula (100 BCF, 95 RCF) between January 2016 and December 2018, following them up for 2 years assessing the outcomes and interventions on their AVFs. The outcomes assessed were primary and cumulative patency at 6 weeks, 6, 12 and 24 months. Multinomial logistic regression to account for confounding variables age, gender, procedure, side, anticoagulant, vessel size and co-morbidities was performed. A Kaplan-Meier analysis of time to endovascular intervention was also performed comparing RCF and BCF. Results Cumulative patency rates for BCF vs RCF were 91% vs. 89% at 6 weeks ( X 2 (3, N = 194) = 4.70, P = .19), 83% vs. 76% at 6 months ( X 2 (3, N = 188) = 7.72, P = .05), 78% vs. 69% at 12 months ( X 2 (4, N = 175) = 5.37, P = .25) and 68% vs. 65% at 24 months ( X 2 (4, N = 161) = 5.24, P = .24). Endovascular intervention rate becomes divergent at 5 months, with the steepest difference between 6 and 12 months. Comparative endovascular intervention rates between BCF and RCF were 20% vs. 31% at 6 months, 41% vs. 40% at 12 months and 40% vs. 49% at 24 months. Conclusion RCF seem to have significantly lower patency at 6 months and have higher endovascular intervention rates compared to BCF. A focussed surveillance protocol could prove effective in improving outcomes for RCF.