Use of short PTFE segments (<6 cm) compares favorably with pure autologous repair in failing or thrombosed native arteriovenous fistulas

Abstract

Short (<6 cm) interposition PTFE segments used for the revision of failing or failed AVFs compare favorably to purely native repair and do not alter the autologous behavior of the initial access. These short PTFE revisions resulted in satisfactory midterm primary patency without further consumption of the venous capital by harvesting segments of vein from other locations and without compromising more proximal access sites. This practice is recommended and is justified as part of an aggressive access salvage policy addressed by many authors so far.

Endovascular versus Surgical Preemptive Repair of Forearm Arteriovenous Fistula Juxta-Anastomotic Stenosis

“…Having shown a three-fold adjusted relative risk for restenosis after PTA by comparison with surgery, our study confirms the results of previous noncomparative studies that reported higher primary patency rates in surgical series than after dilation in failing forearm AVF (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)25,26,28). Moreover, the unadjusted 1-yr primary patency rates in our series (91 Ϯ 6% for surgery and 54 Ϯ 8% for PTA) compare favorably with the literature, which reports rates of 64 to 88% after preemptive surgery (12,19,25,26) and 16 to 79% after endovascular procedures (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

“…Moreover, the unadjusted 1-yr primary patency rates in our series (91 Ϯ 6% for surgery and 54 Ϯ 8% for PTA) compare favorably with the literature, which reports rates of 64 to 88% after preemptive surgery (12,19,25,26) and 16 to 79% after endovascular procedures (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In addition, restenosis rates after the two surgical techniques were similar in our study, failing to support the concern of any higher complication rates' being associated with the PTFE interposition graft (24).…”

“…Both procedures proved to be safe (no major complications were observed after either treatment) and have much the same, very high immediate anatomic success rates, comparable with those previously reported after preemptive PTA (4 -11,13-17) and surgery (12,23,26,28) in AVF.…”

“…The surgical correction of stenosis-creating a more proximal neo-anastomosis (2,12,19,(22)(23)(24)(25)(26), vein-to-vein re-anastomosis (19,23), vein patching (12,23,26,27), or short vein (12,22,23,27) or PTFE graft interposition (12,19,24,26,27)-is a minimally invasive procedure in such easily accessible vessels, it does not use up a long segment of the vein, it involves minimal intimal trauma, and it is likely to be more durable than percutaneous transluminal angioplasty (PTA), because reported primary patency rates in surgical series are higher than after dilation (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(23)(24)(25)(26)28). Some investigators use PTA as the first-line treatment for these lesions, too, however, because it is less invasive and produces excellent immediate primary results …”

Operative salvage of radiocephalic arteriovenous fistulas by formation of a proximal neoanastomosis

“…Where outcomes for a single operative technique have been described, case numbers have generally been small. 9,[12][13][14][15] Larger, more detailed, analyses of outcomes after specific techniques enable more meaningful comparisons between surgical procedures and between surgical and endovascular therapies. The aims of this study were therefore to examine the outcomes and complications of operative salvage of RCAVFs by the NEO technique.…”