Factors Determining the Success of Brescia-Cimino Arteriovenous Fistula in Patients at Bhumibhol Adulyadej Hospital: A Prospective Study
Keywords:
AVF, Arteriovenous fistula, Brescia-Cimino arteriovenous fistulaAbstract
Background: The purpose of this study was to determine factors contributing to the success of Brescia. Cimino arteriovenous fistula. To investigate the feasibility of a Brescia-Cimino arteriovenous fistula if the internal diameter of the cephalic vein was less than or equals to 2.5 mm and if other factors, e.g. age, gender, underlying diseases, radial pulse volume, visible cephalic vein, Allen's test, internal diameter of radial artery and immediate post-operative thrill also played a role in the success.
Material and Methods: A prospective study was undertaken in 120 patients with end-stage renal disease (ESRD) who underwent Brescia-Cimino AVF from March 2003 to August 2004 at Bhumibhol Adulyadej Hospital. The relation between the success of the native AVF and the size of the internal diameter of the cephalic vein as well as other factors including age, gender, underlying diseases, radial pulse quality, visibility of cephalic vein, Allen's test, internal diameter of radial artery and immediate post-operative thrill were analysed. Three months after surgery, the patients were re-assessed to determine the maturation of the AVF for hemodialysis. Thereafter, another 2 sessions of follow-up were required to determine the success of hemodialysis.
Result: The radiocephalic AVFs were performed on the right wrist in 24 patients, left wrist in 96 patients. The operated cephalic veins were externally visible in 101 patients (84.16%) and non-visible in 19 patients (15.83%). The internal diameter of the cephalic vein ranged from 1.0-4.0 mm. Thrill of the AVF immediately after surgery was positive in 111 (92.5%) and negative in 9 (7.50%). Dialysis was successful in 80 patients (66.77%) and failed in 40 (33.33%). There were only 3 factors which contributed to the success of a native AVE, i.e. the cephalic vein visibility, the internal diameter of the cephalic vein and the presence of post-operative AVF thrill. Other factors including age, gender, underlying diseases, radial pulse rate, Allen's test and internal diameter of radial artery had no effect on the success of the native AVF.
Conclusion: Factors contributed to the success of a native AVF included the cephalic vein visibility, the internal diameter of the cephalic vein and the presence of post-operative AVF thrill.
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