Our arteriovenous fistula experiences with grafts in hemodialysis patients

Abstract

Aim: In patients whose life is dependent on hemodialysis, the most suitable vascular access routes are arteriovenous fistulas made with native vessels. However, in patients whose natural vessels are depleted, or not suitable, arteriovenous fistulas can be opened with artificial grafts. Our aim is to examine arteriovenous fistulas opened with synthetic grafts in hemodialysis patients who do not have native vascular access in the upper extremity and share our results.Methods: Patients who underwent opening of an arteriovenous fistula with a synthetic graft to the upper extremities in Adıyaman University Faculty of Medicine, Cardiovascular Surgery Clinic between December 2012 and December 2018 were examined in this retrospective cohort study. They were screened for age, gender, end-stage renal failure etiology, complications in vascular access site, postoperative follow-up, and duration of use. Primary and secondary patency rates were determined.Results: It was determined that synthetic grafts were used in 33 (15 males, 18 females) out of 436 arteriovenous fistulas (AVF) opened to 372 patients. The mean age was 59.2 (17) years. Left radiocephalic (RC) straight graft fistula was opened in 2 patients, left brachiocephalic (BC) straight graft fistula was opened in 12, left BC distal loop AVF in 13, right BC distal loop AVF in 1, left brachioaxillary (BA) distal loop AVF in 3 and right BA distal loop was used to open an AVF in 2 patients. Primary cumulative patency rates were as follows: 72% in the 3rd month, 65% in the 6th month, 42.24% in the 12th month. The secondary patency rates were 33.9% in the 60th month, 12% in the 60th month, 96.96% in the 12th and 24th months, 90.28% in the 36th and 48th months, 59.12% in the 60th month and 43.11% in the 72nd month.Conclusion: In chronic renal failure patients who do not have a natural vascular access routes or whose natural routes have been exhausted, AVFs that are opened to the upper extremities with a synthetic graft are suitable vascular access routes for long-term dialysis.