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[Termino-terminal arteriovenous fistula at the anatomic snuffbox for chronic hemodialytic treatment]
G Simoni1, C Loconte, G Camerini
1Clinica Chirurgica B, Università degli Studi di Genova.
Insights
Anatomical snuffbox arteriovenous fistula (AVF-AS) is a safe, cost-effective option for chronic hemodialysis vascular access. While effective, high thrombosis rates necessitate experienced surgeons for optimal patient outcomes.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Context:
- Chronic hemodialysis requires reliable vascular access.
- Arteriovenous fistulas (AVF) are preferred over grafts.
- The anatomical snuffbox site offers a unique surgical option.
Purpose:
- To evaluate the efficacy and safety of end-to-end arteriovenous fistula at the anatomical snuffbox (AVF-AS) for chronic hemodialysis.
- To compare AVF-AS outcomes with graft vascular access.
- To identify factors influencing AVF-AS patency and complications.
Summary:
- 140 patients underwent AVF-AS between 1979-1989.
- No operative mortality or major complications were observed.
- Median survival was 36 months with 1-year patency at 77.3%; however, 52.9% thrombosis rate highlights the need for surgical expertise.
Impact:
- AVF-AS is a safe, cheap, and vessel-sparing alternative for chronic hemodialysis.
- It offers comparable patency to grafts but with fewer complications.
- The procedure should be reserved for experienced surgeons to mitigate high thrombosis rates.
Abstract:
Between January 1979 and December 1989, an end-to-end arteriovenous fistula for chronic haemodialysis was performed at the anatomical snuffbox (AVF-AS) in 140 patients (49 females and 91 males) with mean age 51 years (range 14-81) referred to our Center from 12 different Hospitals. The choice of the site, on the non dominant arm, depends on the characteristics of the vessels and on the arterial blood pressure. No operative mortality no major complications occurred no distal symptoms related to venous hypertension or arterial steal syndrome or ischaemia. The median survival was 36 months with a patency rate of 77.3% at 1 year, 36.3% at 5 and 18.9% at 10 years. The high incidence of thromboses (52.9%) reflects an excessive compliance with this technique and a lack of expertise on the choice of the proper vessels or an inadequate management of the vascular access. Compared to the graft vascular access, the patency rate is superimposable but with higher rate of complications and lower cost-benefit rate for the grafts. In our experience, the AVF-AS should be, whenever possible, the first step as vascular access for chronic haemodialysis, but the surgical procedure should be reserved only to experienced surgeons. It is safe, cheap and allow to save and use for a longer period the patient's own vessels.