Conductive arterioveous fistula: Comparison of patency rates, complications and outcome with upper arm and elbow [non-conductive] fistulas in a randomized clinical trial

ABSTRACT

A 18 month single-blinded randomized clinical trial was undertaken to compare the patency rate complications and outcome of Conductive arterio-venous creation, a group of techniques using mediancubital and perforating veins for elbow and brachial fistulas, with Non-Conductive [brachiocephalic/brachiobasilic] fistulas in referred patients to SINA hospital for vascular access creation. From may 2001 to December 2002, vascular access procedures were performed for 260 patients.144 patients were followed for patency rate, complications and outcome. Mean age was 53.4 + 16.7 years and 55.5% were male, patency rate was 81% in a 3 month follow up in Conductive and Non-Conductive group. Infection and neuro-muscular complications were not significantly different between groups. 3 venous hypertension and 2 steal syndrome developed in non-conductive group. The major complications, venous hypertension and steal syndrome, were treated by conversion to conductive fistula. In 16 [43%] patients, referred for synthetic graft,conductive fistula was created. Conductive AV fistula is a reasonable alternative for maintenance of hemodialysis access, particularly when other types of brachial and elbow fistula has failed or in cases of major complications. In addition, performing conductive fistula in patients referred for synthetic graft would decrease costs. At the end, further multi-centeral randomized clinical trails are recommended