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Short- and long-term evaluation of arteriovenous fistulas for chronic hemodialysis
D Cassioumis1, M S Fatouros, K C Siamopoulos
1Department of Surgery, School of Medicine, University of Ioannina, Greece.
Insights
Side-to-side arteriovenous (A-V) fistulas for renal failure patients show lower initial patency but better long-term success. Diabetic nephropathy significantly increases A-V fistula thrombosis risk.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Internal arteriovenous (A-V) fistulas are crucial for hemodialysis access in patients with end-stage renal disease.
- Evaluating different A-V fistula configurations is essential for optimizing long-term patency and function.
Purpose of the Study:
- To compare the outcomes of various internal arteriovenous (A-V) fistula configurations in patients with renal failure.
- To identify factors influencing the patency and long-term success of A-V fistulas.
Main Methods:
- Retrospective analysis of 193 internal arteriovenous (A-V) fistulas performed over eleven years.
- Categorization of fistulas based on surgical technique: side-to-side, end-to-side, end-to-end, and brachial artery fistulas.
- Assessment of immediate patency, long-term failure rates, and functional maintenance.
Main Results:
- Side-to-side fistulas (n=157) had lower immediate patency (88%) but reduced long-term failure rates compared to other types.
- End-to-side (90%) and end-to-end (100%) fistulas demonstrated higher immediate patency, often in patients with pre-existing vascular issues.
- Satisfactory function was maintained in 93% of side-to-side fistulas during follow-up.
- Diabetic nephropathy was identified as the primary risk factor for A-V fistula thrombosis.
Conclusions:
- While side-to-side A-V fistulas may have lower initial patency, they offer superior long-term durability for dialysis access.
- Surgical technique and patient comorbidities, particularly diabetic nephropathy, significantly impact A-V fistula outcomes.
- Optimizing A-V fistula selection and management is critical for improving the quality of life for renal failure patients.
Abstract:
One hundred ninety-three internal arteriovenous (A-V) fistulas were performed on patients with renal failure in the last eleven years. The A-V fistulas were divided on the basis of the following: side-to-side between the radial artery and cephalic vein (157 cases); end-to-side between the cephalic vein and radial artery (11 cases); end-to-end between the radial artery and cephalic vein (5 cases); A-V fistulas between the brachial artery and the cephalic, basilic or medial cubital vein (20 cases). The side-to-side A-V fistulas achieved an immediate patency in 88% of cases, lower than each of the other groups. However, the subsequent long-term failure rate was less than the other groups. In addition, satisfactory function was maintained at a high level (93%) during the follow-up period. The end-to-side and end-to-end A-V fistulas showed higher percentages of immediate patency (90% and 100%, respectively), although they were used more often on patients with vascular problems. Diabetic nephropathy was the main factor associated with thrombosis of A-V fistulas.