Secondary Autogenous Arteriovenous Fistulas in the “Fistula First” Era: Results of a Longterm Prospective Study

Abstract

The outflow vein of a dysfunctional arteriovenous dialysis access can be used to create a secondary autogenous arteriovenous fistula (SAVF) (type I). In the absence of an outflow vein, an SAVF can still be created elsewhere in the ipsilateral or contralateral extremity by identifying vessels suitable for SAVF creation (type II). But their patency rates and the use of tunneled dialysis catheters during the postoperative period have not been reported in a prospective fashion. Patients undergoing SAVF creation were included in this analysis. Data were collected prospectively. The primary, secondary, and cumulative patency rates, along with the number of procedures required to maintain patency, were investigated. The need for tunneled dialysis catheters in patients with SAVF before the fistula was ready to support dialysis was also evaluated. Sixty-two (type I, n=35; type II, n=27) SAVFs were created over a period of 5 years. The primary patency rates for types I and II SAVF at 6 and 12 months were 87% and 14% (type I) and 71% and 11% (type II), respectively. The secondary patency rates for type I at 12, 24, and 36 months were 100%, 100%, 83%, respectively, and for type II were 92%, 88%, 83%, respectively. The primary and secondary patency rates between the groups were not statistically significant. The cumulative patency rates for type I at 12, 24, and 36 months were 100%, 100%, 94%, respectively, and for type II were 96%, 96%, and 91%, respectively. Type I required 1.4 procedures/year, and type II needed 1.5 procedures/year (p=nonsignificant). Tunneled dialysis catheters were required in 21 patients with type I and 27 patients with type II SAVF. Although the primary patency rates were not colossal, excellent secondary and cumulative patency rates were observed for SAVF in this study.