NATIONAL HARBOR, MD. – The National Kidney Foundation recommends the preferential creation of radiocephalic fistulas over that of brachiocephalic fistulas for hemodialysis access, but in patients older than 68 years, radiocephalic fistulas are associated with more postoperative complications, according to a retrospective analysis of 287 patients.
Dr. Steven Abramowitz and his colleagues at the Mount Sinai Medical Center, New York, studied patients older than 68 years of age who had preoperative vein mapping and regular follow-up after creation of arteriovenous fistulas. Within this group of 287 patients, 164 underwent radiocephalic fistula (RCF) creation and 123 underwent brachiocephalic fistula (BCF) creation. Dr. Abramowitz presented their findings at the Vascular Annual Meeting.
The researchers analyzed medical records to determine the number of central venous catheter days, the number of fistula-related procedures recorded, and the number of access-related hospitalizations for each patient. Bivariate analysis using linear modeling and one-way analysis of variance was used to assess cohort differences.
Among those patients who had a BCF, the average number of central venous catheter days was 53.3 days per patient, the average number of fistula-related procedures recorded was 0.6 per patient, and the number of hemodialysis-related hospitalizations was 0.3 per patient.
In comparison, among those patients who had an RCF, the average number of central venous catheter days was 83.4 days per patient, the average number of fistula-related procedures recorded was 1.8 per patient, and the average number of hemodialysis-related hospitalizations was 0.8 per patient.
These results indicated a significant difference in postoperative course between those patients who underwent BCF vs. RCF creation.
Patients older than 68 years of age who undergo RCF creation "may have a greater likelihood of increased central venous catheter days, a greater number of hospitalizations related to hemodialysis access, and a greater number of postoperative procedures than those who undergo BCF creation," said Dr. Abramowitz.
He reported that he had no disclosures.