Brachial-Brachial Fistulas Are Highly Morbid and Associated with Poor Maturation and Patency

Arteriovenous fistula (AVF) involving the brachial vein and artery is an infrequently performed autogenous option in patients without suitable cephalic or basilic veins. The purpose of this study was to assess outcomes two-stage brachial-brachial (BrBr) creation. All outpatient AVFs created at two hospitals office-based laboratory between 2016 2019 were reviewed. Demographics, surgical methods, perioperative complications, maturation, patency, subsequent arteriovenous access analyzed. Primary interest maturation patency rates. Secondary included complication rate failed AVFs. We reviewed 312 creations. Median follow-up time 48 months. Twenty-one BrBr fistulas identified. Maturation Br-Br 48% (10/21) as compared 78%/90%/80% for brachial-basilic, brachiocephalic, radiocephalic AVF (P = .007). Time 90 days 101/50/65 brachial-basilic/brachiocephalic/radiocephalic. There no difference demographics comorbidities matured nonmatured BrBr. Three (14%) experienced complications during first stage Five patent 30 never transposed, due refusal three failure before transposition. Sixteen (76%) attempted transposition; 13 completed. Among those that transposition, seven (44%) had (Table). Primary, primary assisted, secondary rates 36 months 15%, 35%, 38%, respectively. most common reasons nonmaturation complete transposition (8/11; 73%) (5/11; 45%). 11 with fistulas, 4 (36%) remained catheter-based dialysis. Seven (64%) upper extremity creation, sic which (86%) on ipsilateral arm. Six these a functional access. Survival 76%. have poor A high percentage undergoing successful alternative creation arm suggesting alternatives should be considered first. These highly morbid procedures reserved select special circumstances whom AV grafts are not feasible.TablePerioperative second creationsFirst (n 21)Second 16)Patients complications14% (3)43% (7)Fistula failure14% (3)31% (5)Arterial thrombosis5% (1)0% (0)Seroma requiring drainage0% (0)6% (1)Myocardial infarction0% (1)Death0% (1)Unplanned admission0% (1)Bleeding transfusion0% (1)Surgical site infection0% (1)Deep thrombosis/pulmonary embolism0% (1)No attempted24% (5)NAValues percent (n). Open table new tab