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Fistula elevation procedure: experience with 295 consecutive cases during a 7-year period
Cathy M Bronder1, David L Cull, Spencer G Kuper
1Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA.
Journal of the American College of Surgeons
|May 13, 2008
Summary
The Fistula Elevation Procedure (FEP) successfully salvages arteriovenous fistulas (AV fistulas) that are too deep for cannulation. This surgical technique improves fistula maturation and long-term patency rates, enhancing dialysis access.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Up to 50% of arteriovenous fistulas (AV fistulas) fail to mature, often due to cannulation difficulties.
- The Fistula Elevation Procedure (FEP) is a surgical technique to improve fistula superficiality for easier cannulation.
Purpose of the Study:
- To review the use of FEP as an adjunct to enhance AV fistula maturation.
- To assess the efficacy of FEP in improving fistula cannulation and long-term patency.
Main Methods:
- A review of 295 FEPs performed between February 1999 and December 2005.
- FEP was indicated for fistulas deemed too deep or difficult to cannulate.
- Kaplan-Meier analysis was used to determine functional primary and secondary patency rates.
Main Results:
- Functional primary patency rates were 73% at 6 months, 60% at 1 year, and 46% at 2 years.
- Secondary functional patency rates were 81% at 6 months, 71% at 1 year, and 59% at 2 years.
- No significant difference in outcomes was observed based on the anatomical site of FEP.
Conclusions:
- FEP can successfully salvage AV fistulas that might otherwise be abandoned due to depth or tortuosity.
- FEP is a valuable adjunct procedure that enhances AV fistula maturation and achieves satisfactory long-term functional patency.