Determinants of Failure of Brachiocephalic Elbow Fistulas for Haemodialysis

Abstract

Primary patency of brachiocephalic fistulas is comparable to that of radiocephalic fistulas. Primary assisted and secondary patency rates can, however, be brought to a much higher level, especially in patients without diabetes and a large-diameter venous outflow tract.

Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates

“…26 Although the autologous AVF is considered the golden standard, the reported 1-year patency rates vary from 36% to 62.5%. [12][13][14][15][16][17][18] In our series, the primary patency was 46% at 1-year follow-up, but dropped to 36.8% after 2 years. Following frequent, mostly endovascular, secondary interventions, we observed primary assisted and secondary patency rates of more than 70% after 2 years.…”

“…10,11 At 1 year, the primary patency rates of autologous fistulas reported in recent literature varies from 36% to 62.5%. [12][13][14][15][16][17][18] To improve this marginal result, several secondary interventions can be performed. Especially percutaneous transluminal angioplasty (PTA) is performed frequently, but also accessory vein ligation, patching, thrombectomy, and urokinase treatment.…”

Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly

“…10 The reported patency of BCAVFs is comparable with that of RCAVFs. 11 However, a prospective study by the same authors of the RCAVF meta-analysis found that when "use for dialysis" is used as an outcome, patency rates are much worse 12 : 41% of RVACFs had failed by 6 weeks, and primary patency at 1 year was 33%. Similarly in an earlier North American study, only 34% of patients developed a RCAVF adequate for dialysis.…”

The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery

“…The patency rates are quite reasonable, meet NKF-DOQI guidelines, [2][3][4] and are in accordance with and sometimes compare favorably with the results of others. [26][27][28][29][30][31][32][33] The results of this study indicate that evaluating individual patients with vascular access indications or postoperative vascular access complications according to a new strict OCP in a regular bimonthly multidisciplinary meeting with all specialists surrounding the vascular access patient improves vascular access patency significantly. Although the total of all revisions, surgical and endovascular, did not differ significantly, a significant decrease of all of surgical revisions and an increase of all PTAs was achieved after the implementation of this new OCP embedded in the bimonthly multidisciplinary meeting.…”