Brachio-basilic Fistula vs. Brachio-cephalic Fistula

Why prefer a fistula?

The goal for arteriovenous (AV) hemodialysis access should always be to increase AV fistula prevalence, since AV fistulas provide patients suffering from end-stage renal disease (ESRD) with a dialysis access with the lowest morbidity and mortality rates and the best long-term patency.

Read more about the pros and cons of AV fistulas

Fistula types

Fistula types are classified as: simple direct — a straightforward fistula since the vein and the artery are used in their normal positions; vein transposition — the vein is moved or transposed to a position that better suits the construction of a fistula; and vein translocation — the vein is removed from its normal anatomical location to another, according to how the fistula is created.

The type of AV fistula should be referred to according to the specific artery and vein that are involved. Although a variety of different anatomic types of AV fistula can be created, most AV fistulas fall into three basic types:

  • Radio-cephalic, which is the radial artery and the cephalic vein
  • Brachio-cephalic, which is the brachial artery and the cephalic vein
  • Brachio-basilic, which is the brachial artery and the basilic vein and tends to be used primarily in patients who have previously had multiple failed access procedures.

According to the clinical practice guidelines of the National Kidney Foundation Kidney Disease Quality Outcomes Initiative (NKF-KDOQI), the order of preference for the creation of AV fistulas is radio-cephalic, brachio-cephalic, and then brachio-basilic transposition.

 

Differences between brachiocephalic and brachiobasilic fistula

Brachiocephalic

  • Created by anastomosing the upper arm cephalic vein to the brachial artery in the antecubital fossa or just above the elbow.
  • Easier to create than a brachio-basilic fistula because it requires less dissection.
  • Easy to cannulate due to its lateral and relatively superficial location.
  • Providing a long length of straight vein from which to select cannulation sites.
  • Offering the potential for a higher blood flow than the radio-cephalic fistula.
  • Showing a slightly higher incidence of vascular steal syndrome.

 

Brachiobasilic

  • Often better preserved and less involved with postphlebitic changes than the cephalic vein, because the basilic vein is more deeply positioned and therefore usually less accessible for venipuncture.
  • Requiring more experience for successful creation: the vein must be elevated and transposed to make it usable as a haemodialysis access.
  • Associated with higher morbidity rates related to its creation.
  • Presenting a less potential cannulation length to work with.
  • More difficult to cannulate.

 

AV fistulas are considered the most preferred vascular access method for dialysis treatment. 

Of the three basic types, the radio-cephalic is the most recommended, followed by the brachio-cephalic, and, only if the other two are not possible, the brachio-basilic.

The VasQ product is designed to improve maturation and patency rates of brachio-cephalic fistulas.