Steven Abramowitz, Angela A. Kokkosis, Jonathan Schwitzer, Harry Schanzer, Victoria Teodorescu
Mount Sinai Medical Center, New York, NY.
OBJECTIVES: The National Kidney Foundation recommends the preferential creation of radiocephalic fistulas (RCF) over that of brachiocephalic fistulas (BCF) for hemodialysis access. This study tested the hypothesis that RCF creation in patients greater than 68 years of age may result in a more postoperative complications.
METHODS: A total of 287 patients older than 68 years of age with preoperative vein mapping and regular follow up after creation of arteriovenous fistula constituted this retrospective study. Within this group, 164 patients underwent RCF creation and 123 underwent BCF creation. Medical records were analyzed for the number of central venous catheter days, the number of fistula related procedures recorded and the number of access related hospitalizations for each patient. Bivariate analysis using linear modeling and one-way analysis of variance was used to assess cohort differences.
RESULTS: Among patients who underwent creation of BCF, the average number of central venous catheter days was 53.3 days per patient, the average number of fistula related procedures recorded was 0.6 per patient and the number of hemodialysis related hospitalizations was 0.3 per patient. Among patients who underwent creation of RCF, the average number of central venous catheter days was 83.4 days per patient, the average number of fistula related procedures recorded was 1.8 per patient and the average number of hemodialysis related hospitalizations was 0.8 per patient. There was a statistically significant difference postoperative course between those patients who underwent BCF vs. RCF creation.
CONCLUSIONS: Patients greater than 68 years of age who undergo RCF creation may have a greater likelihood of increased central venous catheter days, a greater number of hospitalizations related to hemodialysis access and a greater number of postoperative procedures than those who undergo BCF creation.
AUTHOR DISCLOSURES: S. Abramowitz, Nothing to disclose; A. A. Kokkosis, Nothing to disclose; H. Schanzer, Nothing to disclose; J. Schwitzer, Nothing to disclose; V. Teodorescu, Nothing to disclose.
Posted April 2012