Abstract
Introduction:Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively.Methods:This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium.Results:We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003).Conclusions:Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF.
Highlights
Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high
We are not aware of any study that assessed both factors jointly and a single surgeon operating with the same staff throughout the duration of the study. Aiming to study these factors, we propose the following work hypothesis: 1) The surgeon’s skills would have a relevant role in the primary failure rate, and 2) The facility practices would have an important role in the functional primary patency rate during the first year of AVF use
When an AVF showed primary failure and a new access was made, the latter was included only if it was in the other upper extremity since we cannot exclude a modification of the vasculature of the first extremity even if the AVF did function for a few hours
Summary
Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon’s skills and the facility’s practices. We aimed to study these factors, with the hypothesis that the surgeon’s skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively. Results: We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). The surgeon’s skills and facility practices can have an important role in the long term outcome of AVF. There are many factors that contribute to AVF failure: age, female gender, diabetes, and AVF location could be mentioned as very relevant. Two important factors should be taken into account: the experience of the vascular surgeon and the so-called “facility practices” such as nursing skills, time to first cannulation, vascular access surveillance by a dedicated team, etc
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