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NDT Advance Access originally published online on February 24, 2009
Nephrology Dialysis Transplantation 2009 24(7):2190-2194; doi:10.1093/ndt/gfp062
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Characteristic differences in cephalic arch geometry for diabetic and non-diabetic ESRD patients

Mary S. Hammes1, Michael E. Boghosian2, Kevin W. Cassel2, Brian Funaki3 and Fredric L. Coe1

1 Section of Nephrology, Department of Medicine, University of Chicago 2 Department of Mechanical, Materials and Aerospace Engineering, Illinois Institute of Technology 3 Department of Radiology, University of Chicago, Chicago, IL, USA

Correspondence and offprint requests to: Mary Hammes; E-mail: mhammes{at}medicine.bsd.uchicago.edu



  Abstract

Background. Fistula access in chronic haemodialysis patients is recommended. The first and second choice for location of fistula placement is radial-cephalic followed by the brachiocephalic fistula. Fistula access using the cephalic vein often results in cephalic arch stenosis that is less common in diabetics for unclear reasons. The objective of the current study is to determine if geometry of the cephalic arch differs between diabetics and non-diabetics.

Methods. In a retrospective design, 57 patients with brachiocephalic fistula access had radiology films of the cephalic arch reviewed for geometric analysis. Twelve patients were excluded from final analysis because of stent placement in the cephalic arch. Measurements made included diameter of the cephalic vein, minimum radius of curvature and angle of the arch. Demographics were statistically analysed to determine the association with the geometric measurements.

Results. Global and local measurements showed evidence of two arch types. Wider arch angles and larger R/d were associated with diabetes by univariate (P < 0.05) and multivariate analyses (P < 0.05). A wider arch angle was also associated with a history of right permcath access by multivariable analysis (P = 0.042).

Conclusions. Based on this study, it was found that there are two distinct types of cephalic arch geometries. Patients having diabetes mellitus show a significant probability of having a larger R/d ratio and wider arch angle. This study has given insight into structural alterations in geometry of the cephalic arch of diabetics with brachiocephalic fistula access.

Keywords: cephalic arch; diabetics; ESRD; fistula access; haemodialysis

Received for publication: 9. 5.08
Accepted in revised form: 29. 1.09


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