Arteriovenous Fistula in the First Interosseous Space of the Hand for Renal Dialysis

Abstract Background: Brescia-cimino fistula between the redial artery and cephalic vein is the most distal arteriovenous (A.V.) fistula in the upper limb used for renal dialysis. It may be end-to-end or side to side an astomosis. It is still widely used, with long patency rate and minor complications. Aim of Study: To report our experience in AV fistula in the first interosseous space as regards results, complications and factors affecting its patency. Patients and Methods: The study was done between January 2016 and January 2019, 60 A.V. fistulae were created in 55 patients with end-stage renal failure (22 females and 38 males) with a mean age of 45 years (range 20-75) years. All fistulas were done by the same technique. All patients were assessed preoperatively and the A.V fistula was done in the first interosseous space of the non-dominant hand . If (a) The vein is absent, thrombosed or very small (less than 3 mm in diameter). (b) The radial artery is smaller than 1.5 mm or the pulse is not palpable, A.V. fistula was created proximally at the anatomical snuff-pox or at the wrist. Results: 8 cases (13%) of 60 fistulae failed within 24 hours. A further 4 cases (2.5%) failed within 6 weeks (3.5%) not mature enough for haemodialysis and were therefore classified as failure at 6 weeks. The remaining 42 fistulae (81%) matured and were ready for haemodialysis within 6 weeks of construction. Among those, there were 10 cases (17%) late failure between 2 and 24 months. Two patients underwent successful fistula thrombectomy following occlu-sion after one year and one and half year and were able to continue haemodialysis using the same fistula which were patent till the end of our research. 2 cases (3%) lost follw-up; 4 cases (6.5%) underwent renal transplantation with functioning A-V fistula. The remaining 21 cases were alive and maintained on haemodialysis using fistula in the first interosseus space till the end of our study in January 2019. Conclusion: Fistula in the first interosseus space should be concederd the first option of A.V. fistula for renal dialysis if the artery and vein having suitable size for surgery which is 1.5mm. for the artery and 3mm. for the vein.