Fistula Patency Rates Research Articles

Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis.

There is a consensus in the literature that regional anesthesia (RA) improves local hemodynamic parameters in comparison to local anesthesia (LA) during arteriovenous fistula (AVF) surgical construction. However, the effects of both techniques on fistula patency and failure rates are still controversial. The aim of this meta-analysis is to synthesize evidence from published randomized trials and observational studies regarding the safety and efficacy of RA versus LA in AVF surgical construction. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central retrieved six randomized trials (462 patients) and one retrospective study (408 patients). Pooling data using RevMan software (version 5.3) showed that RA was superior to LA in terms of primary fistula patency rate (RR = 1.22, 95% CI [1.08, 1.37], p = 0.0010); however, both types were comparable in terms of primary fistula failure rate (RR = 0.81, 95% CI [0.47, 1.40], p = 0.46). In comparison to LA, RA was associated with improved hemodynamic parameters including fistula blood flow (MD = 25.08, 95% CI [19.40, 30.76], p<0.00001), brachial artery diameter (SMD = 2.63, 95% CI [2.17, 3.08], p<0.00001), and outflow venous diameter (SMD = 0.93, 95% CI [0.30, 1.75], p = 0.004). Postoperative complications were comparable between both groups (OR = 0.23, 95% CI [0.05, 0.97], p = 0.05). In conclusion, RA was associated with higher primary patency rates of AVF and improved local blood flow in comparison to LA; however, both procedures were comparable in terms of primary failure rates and postoperative complications. Larger well-designed trials with longer follow-up periods should compare both techniques in terms of long-term patency rates and safety outcomes.

Patency rate of autogenous arteriovenous fistula after repairment in the patients with late fistula dysfunction/faliure

Objective: To invesitigate 3-year patency rate of autogenous arteriovenous fistula(AVF)in the patients with late fistula dysfunction/failure. Methods: The prospective study was carried out in the First Hospital of Tsinghua University from March 2012 to March 2013. A total of 136 maintenance hemodialysis patients with late AVF dysfunction/faliure who received AVF repairment were enrolled in the study. All the patients were divided into three groups according to surgical procedures: venous neointimal hyperplasia (VNH) stripping group (group A), non-VNH stripping group (group B) and creation of a new AVF group (group C). Patency rate was calculated by survival analysis method, and survival curve of fistula was drawn as well. Results: During 12-36 months follow-up, there were 46 patients with late AVF dysfunction/faliure in group A, 38 patients in group B, and 52 pateints in group C. The AVF patency rate was 88.6% at 12th month, 77.6% at 24th month, and 57.2% at 36th month in group A; 89.3% at 12th month, 74.5% at 24th month, and 55.1% at 36th month in group B; 88.1% at 12th month, 76.8% at 24th month, and 59.0% at 36th month in group C. The AVF patency rates had no statistical difference among three groups at three time points (12th, 24th and 36th month) (P>0.05). Conclusion: The patency rate was high in the patients who recieved AVF repairment. There was no significant difference in the patency rate among three different surgical treatments.

Factors influencing patency of Brescia-Cimino arteriovenous fistulas in hemodialysis patients.

Autologous arteriovenous fistula is gold standard to maintain vascular access for hemodialysis patients. As per the Kidney Disease Outcomes Quality Initiative guidelines, distal veins are preferred as the first choice. In this study, a total of 134 patients and 138 fistulas were evaluated from April 2015 to March 2016. Demographic factors and clinical factors were taken into consideration. Our study showed that age, sex, diabetes, and type of construction (end-to-side vs. side-to-side) had no influence over fistula patency rates. Intradialytic hypotension was one of the risk factors for loss of fistula patency. Smoking and history of hypertension were associated with reduced patency rates (P<0.001). Primary failure was more with distal fistulas (15.2%).

The primary patency of drug-eluting balloon versus conventional balloon angioplasty in hemodialysis patients with arteriovenous fistula stenoses

The aim of this article is to assess and compare the rate of primary patency achieved by drug-eluting balloon angioplasty (DEBA) and conventional balloon angioplasty (CBA) in hemodialysis arteriovenous fistula stenoses. This retrospective study consists of 52 patients with significant arteriovenous fistulas stenoses who were treated with DEBA (n=26) or CBA (n=26) between January 2013 and January 2015. Only those patients with postprocedural technical and clinical success of 100% were selected from the database. Primary patency rates of fistulas at 6 and 12months were evaluated with Doppler ultrasonography as well as clinically. The Kaplan-Meier method was used to compare the primary assisted patency rates for the two groups. The type of AVFs were 41 (78.8%) radiocephalic and 11 (21.2%) brachiocephalic. Primary patency rates between the DEBA and CBA group had a statistically significant difference at 12months (p<0.05). However there was no statistically significant difference at the 6-month follow-up period (p=0.449). There was no statistically significant difference among the patient age, patient gender and fistula type of the two groups (p>0.05). Drug-eluting balloon angioplasty proved to be an effective treatment of hemodialysis AVFs stenosis, with a high primary patency rate at 12months.

Utilidad del mapeo ecográfico preoperatorio para los accesos vasculares de hemodiálisis

ObjectivesTo assess the clinical usefulness of routine doppler ultrasound vascular mapping of upper extremities before creating a vascular access (VA) for haemodialysis. Material and methodsA retrospective single-centre study conducted over a four-year period including end-stage renal disease (ESRD) patients referred to for VA creation for haemodialysis. Patients with previous VA in the same upper extremities were excluded. Two study groups were formed: Physical examination (PE: June 2011-February 2014) and ultrasound mapping (US: March 2014-June 2015). An analysis was performed on the demographic variables, comorbidities and AV location. The results of the patency rates of the radio-cephalic fistulae (RCF) subgroup were recorded, immediately (48h), early (4 weeks), and late (6 months). ResultsThe study included a total 81 patients (42 PE, 39 US), with 63% males. The mean age was 66.5±13.1 years, and 81% were affected on the left side. There were no significant differences between the groups as regards, demographics, comorbidities, or ESRD aetiology. The VA type (PE vs. US): 47.6 vs. 69.2% radio-cephalic fistula* (*P<.05), 38.1 vs. 10.3% brachial-cephalic fistula*, 11.9 vs. 17.9% brachiobasilic fistula, and 2.4 vs. 2.6% humeral-axillary grafts. RCF patency rates: Immediate 90 vs. 85.2%, early 75 vs. 100%*, and late 88.9 vs. 55%*; respectively. However, an increase in AV performed in other territories was observed in PE group (25 vs. 3.7%*) in RCF. ConclusionsRoutine doppler ultrasound mapping of upper extremities before VA creation in our centre allowed the distal vascular territory to be optimised, and improved the primary patency rates of both early and late radio-cephalic fistulas.

Peer review report 1 on “Impact of surgeon factor on radiocephalic fistula patency rates”

Peer review report 1 on “Impact of surgeon factor on radiocephalic fistula patency rates”

Impact of surgeon factor on radiocephalic fistula patency rates.

IntroductionHemodialysis with arteriovenous fistula (AVF) has been widely accepted treatment modality for patients with chronic renal failure (CRF). Radiocephalic fistulas are considered to be the most desirable for the initial vascular access. The aim of this study is to investigate the surgeon factor on radiocephalic fistula patency rates.MethodsA total of 186 patients with diagnosis of CRF underwent Radiocephalic fistula for hemodialysis access were included. Patients were divided into 2 groups according to operating surgeon. Patients were evaluated according to demographic characteristics, secondary patency rates, second AVF creation and complications.ResultsMean age was 57.7 ± 14.8 years. The most common etiology of CRF was idiopathic (66.6%). 40 (75.5%) patients in group 1 and 122 (91.7%) patients in group 2 were pre-dialysis patients (p < 0.05). Overall secondary patency rate was 77.4%. Patients in group 1 and group 2 have secondary patency rates of 83% and 75.2%, respectively (p = 0.458). Second AVF creation was done in 2 (3.8%) patients in group 1 and 23 (17.3%) patients in group 2 (p < 0.05). Postoperative complication rate was 9.6%.ConclusionOperating surgeon is not a major factor of secondary patency in radiocephalic arteriovenous fistulas.

Arteriovenous Fistula Recirculation in Hemodialysis.

Dear Editor, Recently, with great interest we read the review article by Zeraati et al. entitled “A review article: access recirculation among end stage renal disease patients undergoing maintenance hemodialysis” in your most valuable journal (1). The author summarized some of observations about causes and clinical significance of arteriovenous (AV) fistula recirculation, techniques for accurate assessment and main source of pitfall in calculation of access recirculation (AR) (1). Hemodialysis AR occurs when the blood urea concentration in arterial line is lower than that of systemic circulation, indicating that dialyzed blood returning through the venous needle reenters the HD machine through the arterial needle (2). It is well established that periodic assessment of AR and early detection and treatment of this problem has an important effect in better management of hemodialysis (HD) patients (3-5). High degrees of AR reduce solute concentration gradients across the dialysis membrane during HD by mixing dialyzed blood with undialyzed blood and reduce the effective clearance of urea and adequacy of HD. Therefore, presence of AR among HD patients leads to significant inadequate dialysis in long-term, which is an important contributor to morbidity and mortality among these patients (6-11). It is also suggested that high degree of AR is one of the surrogate markers of AV fistula inflow problems and periodic assessment of AR can be used as a screening tool for early detection of this problem, which improves long-term AV fistula patency rates (12). However, it seems that periodic assessment of AR is a neglected issue and most HD centers do not measure AR in HD patients (4). The most common cause of AR is the presence of stenosis in venous side of the AV fistula, which restricts dialyzed blood venous outflow and the other common cause of AR is inadequate arterial blood flow rate because of AV fistula problems (3, 12). Improper needle placement by HD staff which is due to lack of familiarity with the access anatomy is another cause of backflow or AV fistula recirculation and therefore HD staff have to be educated about the role of close proximity and improper arterial and venous needles placement (13). An access diagram should be obtained from the surgeon who constructed the AV fistula for appropriate placement of arterial and venous needles by HD staff. The access anatomy can be determined by temporarily occluding the mid portion of AV fistula. After occluding the mid portion of AV fistula, the portion retaining a pulse is the arterial side and the other portion is the venous side of access (3, 12).

Brachial Artery-Brachial Vein Fistula for Hemodialysis: One- or Two-Stage Procedure-A Review.

Purpose The purpose of the study was to investigate the patency rate of the brachial vein transposition-arteriovenous fistula [BVT-AVF] and to review the available literature regarding the comparison of the one-stage with the two-stage procedure. Methods A multiple electronic health database search was performed, aiming to identify studies on brachial vein superficialization. Case reports and series with five or less patients were excluded from the study. End points of the study were the patency rates at 12, 24, and 36 months of follow-up. The patency of the one- or two-stage BVT-AVF procedure was investigated. Results Overall, 380 BVT-AVFs were analyzed. The primary patency rate at 12 months ranged between 24 and 77%. Rate of early fistula malfunction or failure of maturation of the fistula resulting in loss of functionality ranged from 0 to 53%. Forearm edema, hematomas, wound infection, and early thrombosis were among the most common complications. Limited data were available for the comparison of patency rates between the one- and the two-stage procedure because of the absence of sufficient comparative studies. However, series with one-stage procedure presented a lower patency rate at 12 months compared to series with two stages. Conclusion Patency rates after BVT-AVF, although not excellent, has encouraging results taking into account that patients undergoing these procedures do not have an accessible superficial vein network; failure of maturation and the increased rate of early postoperative complications remain a concern. The BVT-AVF is a valuable option for creating an autologous vascular access in patients lacking adequate superficial veins.

One-year patency rate of native arteriovenous fistulas reconstructed by vascular stripping in hemodialysis patients with venous neointimal hyperplasia

There are limited therapeutic measures for stenosis of arteriovenous fistulas (AVFs) due to venous neointimal hyperplasia (VNH). In the current retrospective study, we reviewed the clinical data of hemodialysis patients who underwent AVF reconstruction by VNH stripping. The primary measure of interest was the secondary patency rate of the restored AVF. The study included hemodialysis patients who underwent AVF reconstruction by VNH stripping (group A), AVF reconstruction proximal to the original fistula (group B), or creation of a new AVF (group C). Patency was evaluated immediately after the surgery and at follow-up visits. Of 353 patients who underwent AVF reconstructions, 327 (91.9%) were for late AVF failure. The final analysis included 305 patients: 76, 128, and 101 patients in groups A, B, and C, respectively. The three groups were comparable in age, sex, causes for AVF, AVF sites, and the artery for the AVF (P > .05). At 3-month follow-up, the secondary AVF patency rate was comparable across the three groups at 93.4%, 92.2%, and 92.1% in groups A, B, and C, respectively. The patency rate at 6 and 12 months was also comparable across groups A, B, and C at 89.5%, 89.8%, and 88.1% at 6 months and 84.2%, 85.9%, and 81.2% at 12 months, respectively. Reconstructing the AVF by surgically removing VNH is an effective technique for late hemodialysis access failure, with maximal preservation of blood vessels.

Never Too Old For an Autogenous Dialysis Fistula? Results of Endovascular Interventions in Nonagenarians

The number of elderly patients in hemodialysis has increased in recent years and nowadays there are significant numbers of nonagenarians. However, there is currently no information in the literature about arteriovenous fistula (AVF) outcomes in patients aged over 90 years after endovascular treatment for stenosis or thrombosis. This retrospective analysis of prospectively collected data included 38 consecutive patients aged over 90 years who were referred for endovascular evaluation and treatment of AVF nonmaturation (n = 11), dysfunction (n = 25), or thrombosis (n = 2) between 2005 and 2013. Median age was 93.9 years, and 24% were diabetic and 47% hypertensive patients. Immature and dysfunctional AVFs were treated by angioplasty, thrombosed fistulas by thromboaspiration. Fistula patency rates were calculated according to the Life-Table method. The immediate overall clinical success rate was 97.4%. Complications included four transient dilation-induced ruptures. Stents were placed for rupture control (n = 3) and major elastic recoil (n = 3), and to rectify a basilic vein pseudoaneurysm developed after dilation. Mean follow-up was 62.6 months. Primary patency rates were 60% and 43% at 1 and 2 years, respectively. Secondary patency rates were 95% and 92% at 1 and 2 years, respectively. Patency rates were not significantly different between immature and dysfunctional AVFs. Endovascular treatment of AVF complications appears to be a valuable approach in nonagenarian patients in view of the low invasiveness, low complication rate, and relatively good long-term patency rates.

Predicting outcomes in native AV forearm radio-cephalic fistulae; the CAVeA2T2 scoring system.

The aim of this study was to identify significant factors relating to fistula survival and create an easy-to-use scoring system for predicting fistula patency rates. A total of 276 consecutive radio-cephalic forearm fistulae created in a single tertiary vascular unit were identified retrospectively. Numerous patient- and fistula-related demographics were noted. Cox regression analysis was used to identify significant factors predictive of reduced fistula patency rates, and significant variables weighted according to their hazard ratio. Five significant factors were identified: ipsilateral Central venous access, Age >73 years, anastomosed Vein <2.2 mm, previous lower limb Angioplasty and absent intra-operative Thrill (1 point for first three variables, 2 points for the latter two). The CAVeA2T2 score (maximum 7 points) significantly predicted for reduced fistula patency (p = 0.001) and a reduced rate of successful dialysis (p = 0.001). Fistulae with CAVeA2T2 scores ≥2 had 6 week and 1 year patency rates significantly below pooled published rates. Without scoring for thrill, that is in the pre-operative setting, the scoring system remained significant at all stages. The CAVeA2T2 scoring system is a potential scoring system for predicting fistula patency rates and the likelihood of dialysing through a fistula. Further studies and/or external validation is required in the context of methodological limitations. How to manage patients with a high CAVeA2T2 score is unknown.

Initial Hemodialysis with a Temporary Catheter Is Associated with Complications of a Later Permanent Vascular Access

The aim was to identify the risk factors of long-term vascular access complications. The study cohort consisted of 239 incident hemodialysis (HD) patients from 1998 to 2010 in a single center. Among these patients, 59.8% had initially been dialyzing with a temporary catheter. Within 3 months after starting dialysis, all catheters had been converted into permanent accesses. 45 patients incurred long-term access complications after the first 2 years of dialysis, and 34 (75.6%) had used a temporary catheter starting HD. Complication occurrence was associated with age, initiation dialysis with a catheter and heart failure by logistic regression (odds ratios were 1.04, 2.77 and 2.23, respectively; p < 0.05). The 2-year primary patency rates of arteriovenous fistulae were significantly higher than those of arteriovenous grafts (79.5 vs. 50%, p = 0.002). We concluded that age, using a catheter and heart failure in HD initiation had a strong impact on long-term access complications.

Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients

The aim of this study was to evaluate the impact of pre-existing radial artery macrocalcification (Mönckeberg type of arteriosclerosis) on patency rates of radiocephalic fistulas (RCFs) in diabetic end-stage renal disease (ESRD) patients undergoing hemodialysis. In this observational prospective study, the long-term patency rates (primary outcome measures) of RCFs in ESRD diabetics who had Mönckeberg radial (±brachial) artery disease (calcified [C] group) were compared with those obtained in ESRD diabetics who had healthy, noncalcified vessels before RCF construction (healthy [H] group). Vessel calcification was assessed by plain two-dimensional radiography. For inclusion in the C-group, uniform linear railroad track-type macrocalcifications of at least 6 cm in length, in the medial wall of the radial artery ipsilateral to RCF creation, were required. Patients were included in the H-group if the radial artery ipsilateral to the RCF creation was free of any macrocalcification, of either intima or media type. Any intimal-like plaque with irregular and patchy distribution was an exclusion criterion for both groups. Patients in both groups also were required to have suitable upper limb vascular anatomy on the basis of ultrasound imaging before RCF creation (cephalic vein of minimum diameter of 1.6 mm, without stenosis or thrombosis in all outflow areas, and radial artery of minimum diameter of 1.5 mm, without proximal hemodynamically significant stenosis). Secondary outcome measures included all-cause mortality. Kaplan-Meier statistics were used for comparison between groups. The arm radiograph at the site of possible fistula construction showed abnormality in 39 patients (C-group, 47 RCFs), whereas 33 patients had noncalcified ("healthy") vascular anatomy (H-group, 40 RCFs). Mean duration of the diabetic disease at the time of RCF creation was 8.9 ± 5.6 years (range, 2-25 years) for the H-group and 14 ± 9.9 years (range, 1-40 years) for the C-group (P = .018). The mean follow-up period for H-group and C-group was 51.9 ± 35.9 months (range, 0.1-126 months) and 26.1 ± 31.6 months (range, 0.1-144 months), respectively (P = .0006). Forty-four patients died during the follow-up period. Primary patency rates at 12, 24, 36, and 48 months for C-group vs H-group were 50.2% vs 80%, 36.5% vs 72.3%, 32.4% vs 67.9%, and 29.1% vs 59.3% (P = .0019). Respective values for secondary patency rates were 52.4% vs 87.5%, 40.9% vs 82.4%, 36.6% vs 78.1%, and 33.2% vs 72.8% (P = .00064). Patient survival rates at 24 and 48 months were 56.1% and 46.4% for C-group and 92.4% and 67.4% for H-group, respectively (P = .05). ESRD diabetics with radial artery Mönckeberg calcifications receiving RCFs had worse late clinical outcomes compared with ESRD diabetics with healthy distal arm vessels receiving the same access. The long-term benefit of RCFs may be lost in diabetics with extensively calcified vessels, and preferably the brachial artery should be used instead.

Surgical versus endovascular management of thrombosed autogenous arteriovenous fistulae

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was: In patients undergoing haemodialysis with thrombosed autogenous arteriovenous fistulae, does surgical management as compared to endovascular management improve clinical outcomes?A total of 130 papers were identified using the search protocol described, of which four represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.Three of the four studies demonstrated no significant difference between the initial success rates of surgical or endovascular management. However, one study illustrated that hybrid surgery (a combination of endovascular and surgical techniques) significantly improved initial success rates, shortened hospital stays and decreased total monetary costs. Furthermore, three studies showed that subsequent fistula patency rates were significantly higher when surgical management was instigated. Nevertheless, one study suggested that surgery worsened subsequent patency rates and that in fact surgical patients were more likely to require temporary dialysis catheters than endovascular patients.Therefore, the clinical bottom line is that with careful patient and fistula selection, surgery provides a number of benefits over endovascular management of thrombosed autogenous arteriovenous fistulae, particularly in the medium to long term. However, further appropriately powered and randomised Level 1 studies are necessary to clarifying this important issue.

Use of short prosthesis segments for brachiocephalic arteriovenous fistulas in elderly hemodialysis population

IntroductionThe autogenous brachiocephalic fistula is a recognized secondary access for hemodialysis. However, veins in the antecubital fossa are often damaged, due to repeated venipunctures and subsequent scarring. Sometimes their anatomy does not enable successful arteriovenous fistula creation. In cases when the proximal part of the cephalic vein seemed patent, during ultrasound Doppler examination, we decided to use a short segment of 6 mm polytetrafluoroethylene graft to connect the vein with the brachial artery. We report our series of this procedure.Material and methodsOver an 8-year period, 34 patients underwent such an operation. Grafts were anastomosed either to the end of the cephalic vein or to the side. The decision was made based on the vein condition: small-caliber veins were considered better for the end-to-side anastomosis. All procedures were performed under local anesthesia, and were well tolerated.ResultsThirty-three fistulas were successfully cannulated at 2-8 weeks after the operation. Fistula patency rates were 84%, 73% and 55% at 12, 24 and 36 months. Comparison of two anastomosis types showed differences, 50% and 62.8% at 36 months, yet without statistical significance (p = 0.27, log-rank test). Fistula patency was not influenced by patient's age, sex or comorbidities.ConclusionsThe described procedure provides satisfactory cumulative patency with an acceptable complication rate. It can enhance the number of cephalic veins used with its main advantages of simple surgical technique and low perioperative morbidity.

Autogenous radiocephalic hemodialysis access in patients with small caliber cephalic veins after expansion with a Fogarty catheter

Autogenous arteriovenous fistula (AVF) is the first choice for hemodialysis access in renal failure with uremia. However, AVF cannot be performed in some patients due to small and narrow veins in the forearm. In this study, a Fogarty catheter was used to establish autogenous radiocephalic hemodialysis access in patients with small caliber cephalic veins, and the patency rate and complications of this method were observed. Sixty-seven patients with uremia were divided into a treatment group (40 cases, caliber of cephalic veins<2.5 mm) and a control group (27 cases, caliber of cephalic veins≥2.5 mm). According to ultrasound results, the treatment group received AVF after expansion with a Fogarty catheter, and the control group received traditional AVF. The fistula patency rate and complications were observed during follow-up. All patients were followed up for an average period of 18 months (range=3-36 months). AVF was successfully used in 58 patients for hemodialysis, with primary access failure in 9 cases (5 cases in the treatment group and 4 cases in the control group) due to early thrombosis. The primary and secondary patency rates 12 months after surgery in the treatment group were 64 and 72%, respectively, and those in the control group were 60 and 76%, respectively. Patients with small caliber cephalic veins can be treated with radiocephalic fistula after the caliber of cephalic veins is expanded to more than 2.5 mm with a Fogarty catheter. The long-term patency rate awaits observation in a longer follow-up period.

Comparison of Efficacy of Side to Side Versus End to Side Arteriovenous Fistulae Formation in Chronic Renal Failure as a Permanent Hemodialysis Access

BackgroundIn candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical.ObjectivesThe present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications.Patients and MethodsSixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests.ResultsIn the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen.ConclusionsThis study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods.

Long-term outcome of upper limb autogenous arteriovenous fistulas for hemodialysis access

Provision of a reliable and durable vascular access for hemodialysis continues to be a challenge for clinicians. The aim of this study was to examine the outcome of upper limb autogenous arteriovenous fistula procedures for hemodialysis and factors influencing access survival. A retrospective review was carried out on 575 patients who underwent 842 consecutive vascular access procedures done over a period of ten-years. The overall primary failure rate was 5.5%, whereas the one- and five-year cumulative access survival rates were 70.0% and 52.1%, respectively. Diabetes mellitus status significantly influenced access survival (P = 0.022). Autogenous arteriovenous fistulas are reliable procedures with access sites often available in both the forearm and the arm. Patients with diabetes mellitus have significantly worse patency rates of upper limb autogenous arteriovenous fistulae.

Metallic dilator use for intraoperative outflow vein dilatation to improve dialysis arteriovenous fistula maturation and accelerate cannulation

Objective: A well-planned and meticulously constructed AVF should mature in 4 to 8 weeks. Creation of a rapidly maturingfistula provides a potential way to diminish the current dependence on central catheter placement. Aim of the work: To evaluate effect of intraoperative dilatation for small veins using metal dilators on the initial autogenous hemodialysis accesses patency, maturation and cannulation. Patients and methods: Sixty adult patients with end-stage kidney disease who were scheduled to undergo radiocephalic (RCAVF) or brachiocephalic arteriovenous (BCAVF) dialysis fistula surgery during the period from August 2010 through August 2011. The primary outcomes of the study were fistula maturation and time of successful first cannulation. Vein diameter was assessed intraoperatively by inserting metal dilator heads to measure the approximate diameter. The relationship between vein diameter after metallic dilators passage and maturation, short­ term patency rate and time to first cannulation were assessed. Results: The patients' age (mean) was 65.9 15 years, range 18-85 years.Preoperative duplex was performed in only 15 (25%) of the cases. Mean duplex cephalic vein diameter was 2.23±0.17mm in successful RCAVF patients and 3.44±0.18 mm in BCAVF. Cumulative primary patency at 6 months in RCAVF patients was 75% (30140 fistulae) and 85% (17120 fistulae) for BCAVF. Matured Fistulas were 49 (81.67%). Eleven fistulas (18.33%) failed to mature; five underwent revision, mostly for failure to mature. Assisted functional maturity was 52/60 (86.67%).0verall mean times for fistula maturation and first cannulation were 32±1.29 days (n=49) and 40±9.6 days respectively. The more increased vein diameters after mechanical dilatation; the more likely for the fistula to mature and the lesser mean time for maturation and cannulation. Conclusion: Early fistula patency rate was better than that in several reports. We recommend careful preoperative patient evaluation as well as careful anastomosis technique, which includes mechanical dilatation for small veins.