The natural history of autologous fistulas as first-time dialysis access in the KDOQI era
| Autor: | Jean M. Panneton, George H. Meier, Marc H. Glickman, Eric C. Scott, Andre Biuckians |
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| Rok vydání: | 2008 |
| Předmět: |
Male
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Time Factors Percutaneous Brachial Artery medicine.medical_treatment Fistula Arteriovenous fistula Arteriovenous Shunt Surgical Renal Dialysis Humans Medicine Vascular Patency Treatment Failure cardiovascular diseases Dialysis Brachiocephalic Veins Retrospective Studies business.industry Vascular surgery medicine.disease Surgery Outcome and Process Assessment Health Care Treatment Outcome Practice Guidelines as Topic Radial Artery Female Guideline Adherence Hemodialysis Cardiology and Cardiovascular Medicine business Follow-Up Studies Kidney disease |
| Zdroj: | Journal of Vascular Surgery. 47:415-421 |
| ISSN: | 0741-5214 |
| Popis: | Background Patients on hemodialysis depend on durable, easily maintained vascular access. The autologous arteriovenous fistula (AVF) has been the gold standard since the introduction of the Brecia-Cimino fistula in 1966 and is echoed in the current Kidney Disease Outcomes and Quality Initiative (KDOQI) guidelines. The purpose of this study is to determine the natural history of AVF in patients requiring first-time permanent access in a large academic vascular surgery practice. Methods We performed a retrospective review of patients undergoing new access creation from January 1, 2005 to June 30, 2005. The study group consisted of patients with no prior permanent access that underwent AVF creation. Categorical data was compared using χ 2 analysis, nominal data was compared using Student t-test, and patency was determined by Kaplan-Meier curves. Results During the 6-month period, there were 80 first time AVF creations. The majority of patients were male (69%), African American (55%), and a history of diabetes (55%) and hypertension (96%). Seventy-five percent of patients were already undergoing hemodialysis via catheter access. Seventy-six percent of patients underwent preoperative vein mapping with a mean vein diameter of 3.1 mm. Twenty-six radiocephalic AVF (RCAVF) and 54 brachiocephalic AVF (BCAVF) were created with a mean follow-up of 278 days. At the end of follow-up, 38 (48%) AVF were being used for hemodialysis and only nine (11%) matured without the need for additional intervention. Mean time for AVF maturation was 146 days. Thirty AVF (37%) were abandoned, 16 (20%) of which were primary failures. Mean time to abandonment was 162 days. Twelve (15%) AVF remained patent but were never cannulated. The intervention rate was 1.33 interventions/patient/year and 75% of interventions were percutaneous. Kaplan-Meier analysis determined primary, primary-assisted, and secondary patency was 36% ± 8.3, 55% ± 6.5, and 55% ± 6.5 at 1 year, respectively. Cumulative functional patency was 63% at 1 year. Conclusions In patients receiving a first time permanent access, we found that the majority were AVF and they resulted in low primary patency rates at 1 year and long maturation times. KDOQI encourages AVF creation in order to increase AVF use for dialysis, but the strategy of simply increasing the number being created may not lead to the desired result and potentially lead to an increase in catheter dependence. |
| Databáze: | OpenAIRE |
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