VESS14. Increased Reintervention in Radial-Cephalic Arteriovenous Fistulae With Anastomotic Angles

Abstract

Objectives: Although radial-cephalic (RC)andbrachialcephalic (BC) fistulae are the recommended primary accesses for hemodialysis, access failure is frequently due to juxta-anastomotic stenosis. Experimental models show that the angle between the artery and the vein can induce disturbed flow that stimulates neointimal hyperplasia.We examinedwhether the anastomotic angle is associated with juxta-anastomotic stenosis and reintervention in RC and BC fistulae. Methods: Between February 2013 and September 2014, anastomotic angle and postoperative vessel diameters were prospectively collected for all patients after RC or BC fistula creation. The primary end point was reintervention on the juxta-anastomotic segment. Secondary end points were primary patency (PP) and secondary patency (SP) of the fistula. End points were calculated using Kaplan-Meier analysis, and multivariable analysis was performed using Cox regression. Results: A total of 149 patients (median age, 72 years) received 73 RC and 76 BC fistulae. Median follow-up was 7 months (range, 1-22 months) for RC and 12 months (range, 2-24 months) for BC fistulae. In RC fistulae, anastomotic angles$30 had fewer reinterventions (3months: 10% vs 36%; 6 months: 34% vs 67%; P 1⁄4 .001). Six-month PP and SP were also higher for angles $30 (PP: 66% vs 38%, P 1⁄4 .003; SP: 97% vs 84%, P 1⁄4 .02). Cox analysis showed that angle .2). Conclusions: Surgeons should ensure an anastomotic angle $30 when creating RC fistulae. Anastomotic angle may not play a role in outcome of BC fistulae.