High radiocephalic versus brachiocephalic arteriovenous fistula in borderline cephalic veins: effect of technique optimization on outcomes

Introduction: Brachiocephalic arteriovenous fistulae (BC AVF) are often preferred over distal fistulae in patients with borderline cephalic veins due to higher reported maturation rates. However, they are associated with increased complications and early utilization of proximal venous access. This study evaluates whether high radiocephalic (RC) AVF with technical modifications can achieve comparable outcomes. Material and methods: This retrospective comparative study included 50 patients with cephalic vein diameter 1.5–2 mm between January 2025 and December 2025. Patients were divided into two groups: High RC AVF (n=25), constructed using modified side-to-side anastomosis with selective intraoperative vein dilatation, and BC AVF (n=25), created using standard end-to-side technique. Primary outcome was functional maturation at 6 weeks. Secondary outcomes included time to maturation, complications, and need for secondary intervention. Results: Maturation rates were comparable between groups (72% vs 80%, p=0.51). The mean time to maturation was longer in the High RC group (44.2 ± 8.6 vs 38.5 ± 7.9 days, p=0.03). Overall complication rate was significantly lower in the High RC group (12% vs 36%, p=0.04). No cases of steal syndrome were observed in the High RC group. Conclusions: High RC AVF using optimized surgical techniques provides comparable maturation outcomes to BC AVF in borderline veins, with fewer complications and better preservation of proximal access.