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The snuffbox arteriovenous fistula for vascular access.
L Wolowczyk1, A J Williams, K L Donovan
1Department of Vascular Surgery, Morriston Hospital, Swansea, UK.
Summary
Snuffbox arteriovenous fistulae are a viable option for hemodialysis access, particularly for men, offering good long-term patency and preserving other vessels. Further consideration for fistula placement may be needed for women with smaller vessels.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Arteriovenous fistulae are crucial for hemodialysis access.
- The snuffbox arteriovenous fistula is an alternative access method.
- Understanding its patency and influencing factors is important for clinical practice.
Purpose of the Study:
- To evaluate the applicability and patency rates of snuffbox arteriovenous fistulae.
- To identify factors influencing the patency of these fistulae for hemodialysis access.
Main Methods:
- Retrospective non-randomized study.
- Analysis of 210 snuffbox fistulae from a database of 645 vascular access procedures (1985-1997).
- Life-table method used for patency analysis.
Main Results:
- Snuffbox fistulae constituted 50% of primary procedures.
- 11% thrombosed within 24 hours; 80% were used for dialysis after six weeks.
- Cumulative patency was 65% at 1 year and 45% at 5 years.
- Patency was significantly better in men and for left-sided fistulae.
- Diabetes, age >70, and prior dialysis did not significantly affect survival.
Conclusions:
- Snuffbox AV fistulae provide a long arterialized vein segment for needling and preserve proximal vessels.
- Feasible in 50% of primary access cases with good long-term patency, especially in men.
- Proximal fistulae may be preferable for women with smaller vessels.