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Vascular access for hemodialysis. Patency rates and results of revision
Insights
Cimino fistulae and PTFE grafts provide durable vascular access for hemodialysis patients. Early Cimino fistula failure stems from inadequate veins, while PTFE graft failure is often due to venous stenosis, which can be corrected for improved graft survival.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Devices
Background:
- End-stage renal disease (ESRD) necessitates reliable vascular access for chronic hemodialysis.
- Arteriovenous (AV) conduits are crucial for effective hemodialysis.
- Evaluating the long-term patency and failure modes of different AV conduits is essential.
Purpose of the Study:
- To assess the 4-year patency rates of Cimino fistulae and polytetrafluoroethylene (PTFE) grafts used for hemodialysis access.
- To identify the primary causes of failure for both types of AV conduits.
Main Methods:
- Life-table analysis was used to evaluate patency rates over a 4-year period.
- A total of 324 AV conduits were created in 256 patients with ESRD.
- Conduit types included Cimino fistulae, PTFE grafts, and miscellaneous grafts.
Main Results:
- Both Cimino fistulae and PTFE grafts demonstrated satisfactory patency for up to 4 years.
- Cimino fistula failures were predominantly early and related to the use of inadequate veins.
- PTFE graft failures were mainly caused by thrombosis, often secondary to venous stenosis.
Conclusions:
- Both Cimino fistulae and PTFE grafts are effective for long-term hemodialysis access.
- Addressing venous stenosis is critical for maintaining PTFE graft patency and prolonging graft survival.
- Careful patient selection and surgical technique are important to minimize early fistula failures.
Abstract:
Over a 4-year interval, 324 arteriovenous conduits were created in 256 patients with end-stage renal disease as access for chronic hemodialysis. These included 154 Cimino fistulae, 163 polytetrafluoroethylene (PTFE) grafts, and seven miscellaneous grafts. Satisfactory patency rates were demonstrated for as long as 4 years for both Cimino fistulae and PTFE grafts by life-table analysis. Failures of Cimino fistulae usually occurred early in the postoperative period, secondary to attempts to use inadequate veins. Thrombosis caused the majority of PTFE graft failures and was generally the result of venous stenosis. Correction of such venous stenosis is mandatory to restore graft patency and can result in prolonged graft survival.