The snuffbox arteriovenous fistula for vascular access.
OBJECTIVE
to determine the applicability, patency rates and factors influencing patency of snuffbox arteriovenous fistulae for haemodialysis access.


METHODS
retrospective non-randomised study.


METHODS
patency was determined by reference to an ongoing database and dialysis records of 645 vascular access procedures between 1985 and 1997, including 210 snuffbox fistulae in 201 patients.


RESULTS
snuffbox fistulae comprised 189/376 (50%) primary procedures. Records of 208 snuffbox fistulae were available for patency analysis by the life-table method. Twenty-two (11%) thrombosed within 24 hours of operation. After six weeks 80% were used for dialysis. Cumulative patency was 65% at 1 year and 45% at 5 years. After thrombosis of snuffbox fistulae, ipsilateral wrist fistulae could be constructed in 45%. Fistula patency was significantly better in men than women (p<0.001) and for left- than right-sided fistulae (p<0.001). Diabetes, age >70 years, and the prior commencement of haemodialysis did not significantly affect fistula survival.


CONCLUSIONS
the snuffbox AV fistula gives a long segment of arterialised vein for needling and preserves proximal vessels. It is feasible in 50% of patients requiring primary access and has good long-term patency, especially in men. A more proximal fistula may be preferable in women with smaller vessels.
Wolowczyk
L
L
Department of Vascular Surgery, Morriston Hospital, Swansea, UK.
Williams
A J
AJ
Donovan
K L
KL
Gibbons
C P
CP
D001166:Arteriovenous Shunt, Surgical / Q000379:methods / Q000706:statistics & numerical data*; D016121:Brachiocephalic Veins / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery*; D006435:Renal Dialysis; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology; D017211:Treatment Failure; D014654:Vascular Patency