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Time-trends in vascular access surgery in Sweden 1987-2006
K-G Ljungström1, T Troëng, M Björck
1Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Division of Surgery, S-182 88 Stockholm, Sweden. karl-gosta.ljungstrom@ds.se
Objective:
To study time-trends in vascular access surgery.
Design:
Prospectively registered data.
Material And Methods:
The Swedish vascular registry (Swedvasc) was searched for haemodialysis access operations (HAO) 1987-2006.
Results:
12,342 open and endovascular operations were identified. Eighty-five percent of HAO 2004-2006 were reported to the registry. The median age of patients having their first HAO increased from 56 to 68 during the first decade (p<0.0001), then remained stable. The frequency of diabetes increased from 12% in 1987 to 32% in 2006 (p<0.0001). The percentage of first HAO of total workload decreased from 76% to 48%. The percentage of first HAO performed as vein fistulas remained unchanged. The number of patients recorded for ten or more previous HAO increased over time. Percutaneous angioplasties increased during the last decade. Of 4706 patients operated on with primary radiocephalic AV-fistulas, 2933 (62%) were operated only once. Analysis of 3739 subsequent operations in 1773 patients disclosed that at the tenth operation vein was still used in 54%. With an increasing number of operations, arterial inflow shifted towards a more proximal position.
Conclusions:
Over time, the patients undergoing HAO became older and more often diabetic, reoperations increased. Despite these circumstances, vascular surgeons perform AV-fistulas without grafts in most patients.
