Timothy K. Liem, Francis Hacker, Ashley A. Price, Amir F. Azarbal, Gregory J. Landry, Erica L. Mitchell, Gregory L. Moneta
Oregon Health & Science University, Portland, OR.
OBJECTIVES: Arteriovenous fistulas (AVF) are the preferred access for patients who require hemodialysis. However, some AVFs require additional surgery to augment maturation. This study determined the effectiveness of AVF revision and the clinical characteristics of patients with poorly maturing fistulas.
METHODS: All AVFs performed over a 5-year period (January 2006 to December 2011) were reviewed, classified as radial-cephalic (RC), brachial-cephalic (BC), brachial-basilic transposition (BVT) and brachial-brachial (BB). Technical factors and co-morbidities for patients with AVFs that matured without assistance were compared with fistulas that required revision or were abandoned. Data were evaluated on a per-patient basis (Chi-square and t-test, p<0.05)
RESULTS: Two hundred ninety-two AVFs were created in 250 patients. One hundred thirty-four of 250 fistulas (53.6%) matured without assistance within an average of 71 days. Patients with AVFs that matured without revision were more likely to be male (60.6% vs. 42.1%, p<0.01), have a lower BMI (26.9 vs. 29.8, p<0.01), and a larger preoperative vein diameter (3.83mm vs. 3.42mm, p<0.02). Fifty-four of 116 non-matured AVFs were revised (70% RC, 26% BC, 4% BVT). The more common revisions were branch ligation (52%), superficial transposition (31%), and anastomotic revision (30%). Eighty-nine percent required one, 9% two and 2% required three revisions to achieve maturation. Average time from index AVF creation to maturation in revised patients was 209 days. Forty-two of 54 patients (79.2%) developing a usable fistula, increasing the overall maturation rate to 70.4%. The most common cause for abandoning a non-mature fistula was thrombosis (62%).
CONCLUSIONS: Surgical revision for poorly maturing AVFs increases overall fistula maturation rates as much as 17%.
AUTHOR DISCLOSURES: A. F. Azarbal: Nothing to disclose; F. Hacker: Nothing to disclose; G. J. Landry: Nothing to disclose; T. K. Liem: Nothing to disclose; E. L. Mitchell: Nothing to disclose; G. L. Moneta: Nothing to disclose; A. A. Price: Nothing to disclose.
Posted April 2013