Study of efficacy and functionality of modified technique of proximal arteriovenous fistula as a vascular access for hemodialysis: A retrospective analysis of 171 cases

Background: Vascular access is the lifeline for a patient on hemodialysis. An arteriovenous fistula is the gold standard for hemodialysis access. The order of preference as given by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines suggests radiocephalic, brachiocephalic, and brachiobasilic transposition fistulae and then prosthetic grafts as vascular access options. Brachiobasilic transposition fistulae are associated with multiple challenges and complications. By our modified technique of brachiobasilic fistula, we have overcome the challenges posed by the conventional technique. In this study, we have evaluated the results of our modified technique and compared them with conventional technique. Materials and Methods: A retrospective analysis was done, in which all cases of proximal fistula for hemodialysis performed in our institute by the modified technique from January 2010 to December 2014 were included in the study. Result: Of the 171 patients, 136 (79.5%) were successful. The primary failure rate was 20.5%. Maturation time required for the fistula to develop was 46.7 (±4.17) days. Flow rates of more than 250 ml/min could be maintained in 58.8% of patients. Patency rates were 79% at the end of 1st year, 74.2% at the end of 2nd year, 45.7% at the end of 3rd year, and 40.2% at the end of 5th year. Ease of access was determined by a number of pricks required to gain access and development of forearm veins. Of the 136 successful cases, 110 (80%) could be cannulated with ease in the first prick itself. Access over forearm was possible in 117 (86.1%) cases. Conclusion: The modified technique of brachiobasilic fistula overcomes the risk of complications and morbidity of conventional brachiobasilic transposition fistula and is equally effective as vascular access