A COMPARATIVE STUDY OF THE DISTAL RADIO-CEPHALIC VERSUS PROXIMAL RADIO-CEPHALIC SURGICALLY CREATED ARTERIO-VENOUS FISTULAS AS THE PERIPHERAL ACCESS FOR MAINTENANCE HEMODIALYSIS FOR END-STAGE RENAL DISEASE

Abstract

BACKGROUND

There are many modalities of vascular access in patients undergoing haemodialysis. The Distal radiocephalic fistula (DRCF) is the most commonly performed peripheral access for ESRD for Maintenance Hemodynamics [MHD]. Due to its high blockage and failure rate, DRCF is swiftly replaced by a Brachiocephalic AVF or a Proximal Radio-Cephalic AVF.

AIM OF THE STUDY

This study aims to compare and contrast the efficacy, outcomes, long-term patency, and failure rate of the PRCF and DRCF in ESRD patients.

MATERIALS AND METHODS

A prospective observational comparative study was conducted at the department of CTVS from December 2023 to March 2025. Data was collected in a semi-structured proforma and entered in Microsoft Excel. If applicable, categorical data was tested using a Chi-square for count and proportion or by Fischer`s exact test. Quantitative data by Mean and SD were tested by unpaired t-test and comparison of the two procedures by the Kaplan-Meier method and evaluated by the long-rank test. A p-value <0.05 was considered statistically significant.

RESULTS

Both groups were comparable in their demographic parameters.  The DRCF group had narrow calibres compared to the PRCF group. Each PRCF group has had a DRCF failure due to narrow and incompatible calibres or thrombus formation. Early failure was lower for PRCF and hence functional longevity. Early failure rates were 7% in PRCF and 17.5%  in DRCF. The patency rate was 83% in PRCF and 70% in DRCF.

CONCLUSION: PRCF should be considered in failed DRCF cases before going in for BCF.