# Snuffbox Versus Wrist Radiocephalic Arteriovenous Fistulas: 10 Years Experience

## TL;DR

This study compares two types of vascular access procedures for hemodialysis and finds the snuffbox arteriovenous fistula to be a viable option.

## Contribution

The study provides a 10-year analysis of snuffbox versus wrist arteriovenous fistulas for hemodialysis access.

## Key findings

- Snuffbox AV fistulas showed no significant difference in failure rates compared to wrist fistulas.
- Fistula failure was significantly associated with complications.
- The snuffbox AV fistula is a feasible first-choice option for hemodialysis patients.

## Abstract

Background

The wrist radiocephalic arteriovenous fistula (RCAVF) is the initial suggested procedure for establishing hemodialysis vascular access (HVA) in the most distal site of the upper limb. The anatomical snuffbox arteriovenous fistula (SBAVF) is barely utilised, despite its remote location. In this study, we aimed to analyse and compare the results of SBAVF and RCAVF in terms of their maturity, patency, and failure rates.

Methodology

This descriptive, retrospective study compared outcomes between SBAVF and RCAVF in terms of maturation, patency, and failure. All patients with chronic kidney disease who attended and underwent either procedure at Betsi Cadwaladr University Health Board between 2013 and 2023 were studied.

Results

In a period of 10 years, 179 patients were included. Overall, 102 (57%) were male and 77 (43%) were female, with a male-to-female ratio of 1.3:1. Wrist radiocephalic fistula was the dominant type of surgery done in 76% (n = 136), while the snuffbox radiocephalic fistula was done in fewer than 24% (n = 43) of patients. Most patients underwent a successful arteriovenous (AV) fistula (n = 105, 58.7%), in contrast to 67 patients whose fistulas failed. There was a significant relationship between fistula failure and complications (p = 0.000). There was no significant effect of the fistula site, hypertension, diabetes, cardiac diseases, smoking, peripheral vascular disease, or central vein stenosis on the failure of the AV fistula (p = 0.127, 0.534, 0.510, 0.397, 0.017, 0.68, and 0.371, respectively).

Conclusions

The snuffbox AV fistula is a suitable and feasible first choice for patients on hemodynamic therapy.