Baktiroglu Selcuk, Yanar Fatih, Ozturk Alper
Istanbul University, Istanbul Medical Faculty, General Surgery Clinic, Istanbul - Turkey.
J Vasc Access. 2015;16 Suppl 9:S29-33. doi: 10.5301/jva.5000377. Epub 2015 Mar 8.
Brescia-Cimino radiocephalic arteriovenous fistula (AVF) remains the first choice vascular access procedure for patients in need of long-term hemodialysis. Brachiocephalic fistulas are considered as a secondary option in almost all published guidelines. Recently in many reports, elbow and upper arm fistulas are recommended to be used as primary fistulas especially in elderly, diabetic, hypertensive patients. Elbow fistulas (brachiocephalic and brachiobasilic) should only rarely be constructed as primary fistulas. Forearm AVFs should be tried first to give a chance to the patient, because it is not the maturation-patency rates per se but also lowering the complication rates and saving the vessels for future use are equally important.
The average life expectancy of patients receiving hemodialysis has increased in recent years and many patients now live longer and require secondary or tertiary procedures.
When forearm fistulas have failed, brachiocephalic AVF is usually preferred first, because of cephalic vein's appropriate anatomy for easy cannulation and ease of the operation. Operative procedure is less invasive compared to brachiobasilic AVF, therefore BC should be the procedure of choice when both veins are available.
