ORIGINAL ARTICLES   

Minerva Urologica e Nefrologica 2007 September;59(3):231-6

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: English

The role of autologous antebrachial arteriovenous fistola in the strategy of access planning for chronic uremic patients on hemodialysis

Szeberin Z. ¹, Bíró G. ¹, Sótonyi P. ¹, Soós P. ¹, Százados M. ¹, Árkossy O. ², Berta K. ³, Acsády G. ¹

¹ Department of Cardiovascular Surgery Semmelweis University, Budapest, Hungary 2 Fresenius Dialysis Centre St. Margaret Hospital, Budapest, Hungary 3 Semmelweis University Dialysis Centre Budapest, Hungary

Aim. The number of arteriovenous (AV) fistula creation increases worldwide. Haemodialysis is more effective, patients live longer, and they need more access operations. The optimal strategy for the order and sequence of the different type and localization of AV fistulas remains obscure. Based on internationally acclaimed guidelines, autogenous access should be performed whenever possible and the first operation of choice is the radiocephalic fistula at the wrist, the second type is the elbow fistula. The area between the standard exposures means also good access area and its usage is not emphasized properly. Our aim was to study the short and long-term the results of autologous forearm fistulas.
Methods. Between 1997 and 2005 we performed 1018 AV shunts in an academic tertiary care centre. Ninety-seven autologous antebrachial AV shunts were performed. The average follow-up time was 31.3 months. We examined the patency rate and its connection with different variables such as diabetes mellitus, acute or chronic operative situations, indications for surgery, diameter and quality of the vein.
Results. The primary patency rates were 93%, 79.5% and 61.2% at the end of years 1, 2 and 6, respectively. The patency rate was not significantly affected by any of the examined variables mentioned above.
Conclusion. The patency rate of the autologous antebrachial AV shunt is comparable to the wrist and elbow fistulas, so our results support the practice of performing fistula at this atypical localization. Proximal autologous fistulas and prosthetic graft implantation could be postponed, this way valuable time could be saved for the uremic patients.