Fistula use after concurrent arteriovenous fistula formation and Tenckhoff catheter insertion

Abstract

A significant proportion of peritoneal dialysis (PD) patients will have abrupt technique failure requiring conversion to haemodialysis, often using temporary vascular catheters as bridging access. However, vascular catheter use has been associated with increased mortality and great effort has been made to reduce their use. Just under two decades ago, a trial of dual arteriovenous fistula (AVF) formation and Tenckhoff catheter insertion reported only 4% of those in whom back-up fistulae were formed ever used them. Patient demographic, surgical technique and fistula care over those decades have changed substantially, potentially making this practice feasible. Thirty-five selected patients at Concord Repatriation and General Hospital had AVF formed at the time of Tenckhoff insertion and were entered prospectively into a vascular access database. We retrospectively examined this database with a median follow up of 345 days (interquartile range 183-658). Thirty-one per cent of all patients used the preformed AVF, and a further 19% who were still on PD had clinically functioning AVF. The vast majority (62%) had abrupt PD technique failure. This is a marked difference to dated reports of AVF use after concurrent PD and AVF formation. It raises the possibility that the formation of back-up fistula may be another method to reduce the need for vascular catheter use.

Planning Vascular Access in Peritoneal Dialysis—Defining High-Risk Patients

“…This can be due, in part, to active AVF surveillance by our PD staff. Furthermore, a great number of patients did not use the access created (60%), but this percentage was clearly inferior to previous studies (7,23). Interestingly, there was no difference in usability of AVF depending on its location.…”

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

“…The backup AVF resulted in a reduction of CVC placements; however, the majority of originally placed AVF (94%) were never used. The second study was from Australia and included 35 ESRD patients who underwent PD catheter placement and backup AVF creation (16). During a median 345 days of follow-up, 16 patients experienced PD interruption requiring HD: 6 patients used CVC due to non-functioning AVF and 10 patients used preformed AVF, thus reducing CVC use to 37.5%.…”

Utility of ‘back‐up’ arterio‐venous fistulae in patients on peritoneal dialysis and use of haemodialysis catheters

“…13 There have been no data in this area for almost a decade until Jiang et al in 2013 reported that AVF were successfully used in 31% of patients with preformed AVF and a further 19% who were on PD had functional AVF. 9 In that study, 62% of the patients suffered sudden and unexpected PD technique failure. The findings in the present study of the successful use of back-up AVF in 67% of patients requiring transfer may possibly be indicative of different patient demographics, surgical techniques, AVF patency rates or surveillance of the AVF.…”

“…[4][5][6][7][8] A retrospective study by Jiang et al highlighted the importance of creating 'back-up' AVF to minimise the burden of HD catheter exposure. 9 It has been argued previously that these fistulae have high failure rates and require several interventions to be functional at the time of need. 10 The Royal Adelaide Hospital (RAH) has a policy of creation of back-up AVF at the time of insertion of Tenckhoff catheter in all patients who opt for PD, unless there are over-riding reasons for not doing so.…”