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Immediate postoperative complications following hemodialysis access procedures
1Department of Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania, USA.
International Surgery
|January 1, 1996
Summary
Autogenous fistulas are the preferred initial choice for hemodialysis access. Graft fistulas show a higher complication rate, especially in patients with prior access procedures, necessitating surgical intervention.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Permanent hemodialysis requires reliable vascular access.
- Arteriovenous fistulas are a common type of vascular access.
- Graft fistulas are frequently used, particularly in patients with previous access attempts.
Purpose of the Study:
- To compare the early postoperative complication rates of autogenous versus graft arteriovenous fistulas for hemodialysis.
- To evaluate the impact of previous access procedures on fistula complications.
Main Methods:
- A retrospective review of 173 arteriovenous fistulas (49 autogenous, 124 graft) constructed between 1989 and 1994.
- Analysis of immediate postoperative complications, including hemorrhage, thrombosis, hypotension, and sepsis.
- Assessment of the association between previous access procedures and complication incidence.
Main Results:
- Graft fistulas had a higher incidence of immediate postoperative complications (10.6%) compared to autogenous fistulas (4.1%).
- Complications in graft fistulas were often linked to prior access procedures and required surgical exploration.
- While not statistically significant, the trend favored autogenous fistulas for fewer early complications.
Conclusions:
- Autogenous fistulas should be prioritized as the primary hemodialysis access in suitable patients.
- Graft fistulas are associated with increased early complications, particularly in re-operative cases.
- Careful patient selection is crucial for optimizing hemodialysis access outcomes.
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