Five years' experience in access surgery for polychemotherapy. An analysis of results in 100 consecutive patients

In 100 consecutive patients with various malignancies, 142 operations were performed to establish an arteriovenous fistula giving vascular access for chemotherapy. The fistula of choice was always an end-to-side fistula between the cephalic vein and the radial artery (radiocephalic fistula). A fistula of this type was established in 88 operations on 76 patients and functioned well in 64% of this group. In 29 patients in whom this fistula failed or was not feasible, an elbow fistula was performed in 32 operations and functioning well in 59%. In 13 patients whose arms offered no alternative possibility, 15 long saphenous vein (LSV) autografts were implanted in the inguinal region. A radiocephalic fistula was successfully performed in 77% of the patients who had received preoperative chemotherapy during less than 4 weeks, versus 26% of those who had received preoperative chemotherapy during a longer period. The radiocephalic fistula is the fistula of choice to gain vascular access for chemotherapy. It has proved necessary to perform this operation before chemotherapy is started. When this type of fistula is not feasible, alternatives are an elbow fistula or an (LSV) autograft in the inguinal region.