Brachiocephalic Fistula – Cardiovascular Clinic

Introduction

A brachiocephalic arteriovenous fistula (AVF) is a surgically created connection between the brachial artery and the cephalic vein in the upper arm. It is a standard vascular access type for patients requiring long-term hemodialysis, especially when more distal veins are unsuitable or have failed.

Why and When It’s Done

  • Provides a high-flow, durable vascular access for patients with end-stage renal disease (ESRD) who require hemodialysis.
    • Considered when wrist or forearm veins are too small, scarred, or otherwise unsuitable, making a more proximal option preferable.

Procedure Overview

  1. Preoperative evaluation, including ultrasound and possibly venous mapping, to confirm vessel size and anatomy.
    2. Under local or general anesthesia, the surgeon dissects the cephalic vein and brachial artery, mobilizes them if needed, and connects them by anastomosis.
    3. After surgical connection, the vein arterializes, thickening and enlarging under increased blood flow to become suitable for dialysis.

Benefits and Limitations

Pros: Lower infection risk than synthetic grafts, better long-term patency, and fewer complications when well-maintained.
Cons: Risks include steal syndrome, cephalic arch stenosis, thrombosis, failure to mature, and infection.

Aftercare and Monitoring

  • Regular monitoring by the vascular access team through clinical checks, ultrasound, and interventions if needed.
    • Daily self-checks by the patient: feeling the vibration (‘thrill’), keeping the arm clean, avoiding tight clothing, and reporting swelling, pain, or bleeding.
    • Activity modifications: avoid lifting heavy objects for a few weeks, keep the wound dry, and follow fistula maturation exercises.

When a Brachiocephalic Fistula Might Not Be Ideal

  • Patients with poor arterial inflow or central venous stenosis may require alternative access types.
    • If there is a high risk of steal syndrome or inadequate veins, alternatives include basilic vein transposition, graft, or tunneled catheter.

Frequently asked questions!

Open heart surgery may be necessary to treat coronary artery disease, valve disorders, or congenital heart defects. It is recommended when medications or less invasive procedures are no longer effective.

Common types include CABG (coronary artery bypass graft), valve repair or replacement, ascending aortic surgery, or combined operations depending on your condition.

The procedure may last 3–6 hours or more. Recovery usually takes 6–12 weeks, depending on the complexity of the surgery and overall health.

The chest is opened, and a cardiopulmonary bypass machine may be used to take over heart and lung function while the surgeon repairs the heart.

Possible risks include bleeding, infection, irregular heartbeat, stroke, and complications related to anesthesia. Your surgeon will discuss individual risks with you.

You may need to stop certain medications, undergo lab tests, quit smoking, improve diet, and follow lifestyle changes as advised by your doctor.

Patients usually stay in the ICU right after surgery, then move to a regular ward. Hospital stays are often 4–7 days unless complications occur.

Cardiac rehabilitation programs, medications, lifestyle adjustments, and regular follow-up visits are essential for full recovery.

Many patients feel better after 4–6 weeks, but full recovery can take 3 months or more, especially for heavy physical activity.

Call your clinic if you experience chest pain, new shortness of breath, fever over 38°C, swelling around the incision, dizziness, or irregular heartbeat.