PS108. Outcomes Analysis of the Pluripotential Antecubital Vein Dialysis Fistula

Abstract

The use of a native arteriovenous fistula (AVF) for dialysis is associated with fewer overall complications, and preserving long-term patency is a priority. The purpose of this study is to compare the patency and number of secondary interventions required of AVF when aneurysms are repaired with interposition prosthetic grafting (IG) vs aneurysm plication (PC).Methods: Fourteen patients with symptomatic aneurysms (15) of upper extremity autologous AVFs were treated with PC (eight) and IG (seven) between July 2007 and November 2013 at a single institution. The indications for operation were cutaneous thinning, ulceration, bleeding, and difficulty in cannulation. Patient characteristics, type of repair, patencies, and number of secondary interventions were recorded and analyzed.Results: Fourteen consecutive patients (nine men) with mean age of 48 years, underwent 15 aneurysm repairs. Five patients (33%) had radiocephalic, nine (60%) brachiocephalic, and one (7%) brachiobasilic AVF with the mean follow-up of 9 months. Eight aneurysms (53%) underwent plication vs seven (47%) interposition grafts. The average diameter of the aneurysm was 2.6 cm (IG) and 2.8 cm (PC) (not significant). At 6 months of follow-up, the patency for PC was 62.5% vs 57.1% for the IG group (P > .4). One IG was excised due to infection and another was lost due to an unrelated death. Two patients in the PC group were converted to IG due to aneurysm extension. Overall, IG patients required eight times more procedures (five dialysis catheters and three endovascular interventions) vs 1 intervention for the PC group (P < .01).Conclusions: Preliminary results show that aneurysm PC extends the life of the native fistula and requires fewer interventions to maintain patency. When possible, this method should be considered as the repair procedure of choice for AVF aneurysms.