Brachiocephalic fistula

Last revised by Dr Daniel J Bell on 13 Jul 2021

A brachiocephalic fistula is a form of acquired arm arteriovenous fistula usually performed for chronic haemodialysis.

Criteria for adequate vasculature

Reported criteria include:

  • arterial diameter of >2 mm
  • vein diameter of >2.5 mm, while a tourniquet or blood pressure cuff is applied
Drawbacks
  • precludes the opportunity for the subsequent creation of a more distal fistula

Complications

Reported complications include:

  • steal syndrome: 5-20 x greater rate of steal syndrome than in those with a radiocephalic fistula 3
  • cephalic arch stenosis (CAS): haemodynamically significant cephalic arch stenoses may form a considerable proportion (reported range 30-77%) of dysfunctional brachiocephalic fistulae 3

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