IP153. Snuffbox Arteriovenous Fistulas Have Similar Outcomes and Patency to Wrist Arteriovenous Fistulas

Abstract

Radial artery-based wrist arteriovenous fistulas (WAVFs) are a common site of initial upper extremity arteriovenous access. However, data on more distal access, such as in the anatomic snuffbox AVF (SBAVF), are unclear. Our goal was to compare perioperative and midterm outcomes between the two types of distal accesses. The Vascular Quality Initiative database was queried for all patients undergoing SBAVF and WAVF from 2011 to 2017. Multivariable analysis was performed to analyze outcomes. We identified 4525 distal arm fistulas (179 SBAVFs and 4346 WAVFs). The average age was 59 ± 14.7 years, and 72.3% were male. There were no differences in the patients’ demographics or comorbidities aside from SBAVF patients more often without a tunneled line (70.2% vs 65.2%; P = .046). There was no difference in steal (0.8% vs 1.9%; P = .34) and wound infection (0% vs 0.2%; P = .65) reported within 6 months. Kaplan-Meier analysis shows there was no difference between SBAVF and WAVF at 6 months for primary patency (51.2% vs 49.9%; P = .65), freedom from surgical revision (88.7% vs 84.7%; P = .09), freedom from endovascular revision (92.5% vs 95.7%; P = .46), and survival (92.5% vs 96.3%; P = .23). SBAVF compared with WAVF did not affect primary patency (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.75-1.26; P = .83), surgical revision (HR, 0.61; 95% CI, 0.35-1.05; P = .074), endovascular revision (HR, 0.96; 95% CI, 0.65-1.42; P = .83), and survival (HR, 1.47; 95% CI, 0.9-2.4; P = .128). SBAVFs have similar midterm results to those of WAVFs. When adequate vein is available, this represents an additional site for distal access to help preserve more proximal access sites for future use.