Primary and Secondary Patency Rates and Complications of Upper Extremity Arteriovenous Fistulae Created for Hemodialysis

Abstract

ATES, A., ÖZYAZICIOĞLU, A., YEKELER, I., CEVIZ, M., ERKUT, B., KARAPOLAT, S., KOÇOĞULLARI, C.U. The types of fistulae used and their complication rates are important for the hemodialysis patients. We aimed to compare retrospectively the primary and secondary patency rates and complications of upper extremity arteriovenous fistulae. Between 1984 and 2005, a total of 1,233 upper extremity arteriovenous fistulae were created in 920 patients. The mean age was 42 ± 21 years. The fistulae were divided into the 3 groups; 588 radiocephalic, 205 brachiocephalic, and 127 were created by polytetrafluoroethylene graft. The fistulae types were evaluated with regard to their primary-secondary patency rates and complications. There was a significant difference with regard to development of thrombosis in radiocephalic group compared to other two groups, respectively, p = 0.0122, p = 0.0091. In brachiocephalic fistulae group, edema and steal phenomenon were statistically significant ( p < 0.0001). The aneurysm formation was statistically significant in polytetrafluoroethylene fistulae graft group ( p < 0.0001). During 6 months, 2 and 5 years period, while primary patency rate was higher in three fistulae types, in radiocephalic fistulae both primary and secondary fistulae patency rates were lower ( p < 0.05). To create successful arteriovenous fistulae with long-term patency, appropriate veins of patients should be carefully preserved; thus initially a distal site should be preferred, and in case of failure the next fistulae should be created proximally. In case of failure of forearm fistulae, primary fistulae with autogenous veins should be tried at the upper arm first, and if this also fails, fistulae formation with synthetic grafts should be considered. arteriovenous fistulae; upper extremity; surgical techniques; patency rate

Fistula First Initiative

“…Recent studies have also found that when thrombosed, grafts are more successfully treated with radiologic intervention with a 63% 6-mo postinterventional patency rate compared with 22% in AVF (79,80). Some studies have also shown superior graft primary and secondary patency compared with AVF (33,81), especially when it is a second access (72). Indeed, with multidisciplinary care, graft survival has progressively improved in the past decade and can exceed K/DOQI recommended patency rates (82).…”

“…They have been found to have higher rates of complications such as aneurysms (81,84,85) and have a significantly greater risk for infection compared with AVF (71). Historically, they have required more interventions to manage stenosis and thrombosis (71); however, with the introduction of the CPM indicator of structured routine monitoring and intervention, thrombosis rates are now low (86,87).…”

The Last Option Before the Prosthetic Graft in Arteriovenous Fistula Formation: Brachiobasilic Vein Transposition

“…Se kon der açık ka lım üst eks tre mi te prok si mal seg ment ler de oluş tu ru lan AVF 'de da ha ba şa rı lı ol du ğu bil di ril miş tir. 13,14 Ça lış -ma mız da bu bul gu lar la uyum lu dur ve se kon der açık ka lım her iki grup ta da yük sek sey ret miş tir. Se konder açık ka lım ça lış ma mız da cer ra hi ile sağ lan dı ancak Mad ran ve ark.…”

Assessment of the Hemodynamics of Autogenous Arteriovenous Fistulas With 4D Phase Contrast‐Based Flow Quantification MRI in Dialysis Patients

“…AUTOGENOUS ARTERIOVENOUS FISTULA (AVF) is the most commonly used method for delivering hemodialysis (HD) in patients with endstage renal disease (ESRD) . However, some patients with AVFs can develop local complications, resulting in dialysis dysfunction .…”