title: Failure of dialysis access: revise or replace?
abstract: Providing adequate long-term dialysis access has become increasingly difficult. In order to evaluate the operative factors associated with early failure of dialysis access, 2337 operations performed in 1124 patients over an 8-year period were retrospectively reviewed. Evaluation of 1306 procedures that eventually failed and required operative revision or repair provided the basis for this study. Access failure occurred in 459 (41%) of the 1124 patients. An average of 2.8 episodes of failure (range 1-13) were observed among this group of patients, occurring after an average of 230 +/- 9 days (mean +/- ++standard error) postoperatively, with the longest interval to failure being 2529 days. The time-to-failure for revision of a preexistent arteriovenous fistula or prosthetic graft (140 +/- 9 days, n = 449) was significantly (P < 0.0001 ANOVA) shorter than for creation of an arteriovenous fistula (272 +/- 21 days, n = 336) or prosthetic graft (299 +/- 19 days, n = 372) at a new site. Procedures performed in octogenarians tended to fail earlier (178 days). Dialysis access failure tends to recur in patients with a history of previous access problems. The time-to-failure was similar for new prosthetic grafts and arteriovenous fistulas, but twice as long compared to revision of a previous access site.
authors.affiliation: Ralph Henry Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina 29425, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Brothers
authors.forename: M
authors.initials: M
authors.lastname: Morgan
authors.forename: J G
authors.initials: JG
authors.lastname: Robison
authors.forename: B M
authors.initials: BM
authors.lastname: Elliott
authors.forename: P
authors.initials: P
authors.lastname: Baliga
authors.forename: J B
authors.initials: JB
authors.lastname: Cofer
authors.forename: P R
authors.initials: PR
authors.lastname: Rajagopolan
authors.forename: C T
authors.initials: CT
authors.lastname: Fitts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors