• Vascular Annual Meeting
• General Information
• Exhibitor Information
• Future Meeting Dates
• Past Meeting Information
• Contact Us

Home > Vascular Annual Meeting > motaganahalli_abandon_dysfunctional

Should We Abandon Dysfunctional Arteriovenous Fistulas? Alternative Technique to Vein Transposition by Conversion to Arteriovenous Graft with Inflow from Fistula – Description and Results of a New Surgical Procedure

Raghunandan L. Motaganahalli, Pawel T. Dyk, James R. Mark, Melissa Grammer, Paul G. Garvin.
St Louis University School of Medicine, St Louis, Mo.
 
OBJECTIVES: Failure to mature / Difficulty to access is a major problem associated with the autogenous Arteriovenous (AV) fistulas. Despite the out flow system meeting the criteria for the construction of the AV fistula approximately 20-30% brachio-cephalic fistulas will fail to mature. These patients will need alternatives with either a brachio-basilic vein transposition or relocation of the access procedure to a more proximal site. This results in limiting the options available for future access procedures. We describe a new technical modification by conversion to an AV graft by utilizing the inflow from these AV fistulas which otherwise are patent and dysfunctional. We discuss the technique, early and mid-term results.

METHODS: We performed 651 vascular access procedures between 2002 to 2007. We adapted this new surgical procedure preserving the inflow and outflow with conversion to AV graft from patent fistula in 82 patients (see diagram). Patients selected had a patent fistula which were either difficult to access due to depth or due to non-maturity. All these patients had a satisfactory distal outflow as evaluated at surgery. Retrospective analysis was performed for primary and secondary patency, complications. We also compared the results with our own series of patients having a forearm and arm ‘C’ loop grafts

RESULTS: AV grafts were placed in 82 patients using the inflow and outflow of a failure to mature, dysfunctional AV fistulas. Primary and secondary patency at 6mts, 1year, and 2years was 70.5%, 53%, 45% and 89%, 74%, 71% respectively. The results were comparable to our forearm loop grafts and arm ‘C’ loop grafts with 6 months, 1 year, and 2 year patency of 72.0%, 65.9%, 52.8% and 76.5%, 66.9%, 56.3% respectively. Survival function was analyzed by Kaplan-Meier method. Complications were encountered in 18 patients (graft infection-8, thrombosis-9 patients, combined infection with thrombosis-1 patients).

CONCLUSIONS: The procedure described here offers a safe, satisfactory, alternative option, including the advantages of a fore arm loop graft for those patients who have a patent AV fistula which other wise fails to mature or difficult to access. This surgical modification should be considered in lieu of a new access site and before abandoning the fistula.

AUTHOR DISCLOSURES: R.L. Motaganahalli, None; P.T. Dyk, None; J.R. Mark, None; M. Grammer, None; P.G. Garvin, None.