Factors predictive of failure of Brescia-Cimino arteriovenous fistulas.
OBJECTIVE
To evaluate patency rates of Brescia-Cimino fistulas and to find out which independent factors were predictors of failure.


METHODS
Retrospective clinical study.


METHODS
University hospital, The Netherlands.


METHODS
150 consecutive patients (mean age 56 years, range 17-80) who had 153 primary Brescia-Cimino fistulas created during the 5-year period January 1995-December 1999.


METHODS
Patency rates calculated by the Kaplan-Meier method and the possible predictive value of 20 different variables assessed by Cox's proportional hazard model.


RESULTS
The primary patency rate was 70% at 3 months, and 7 distinct factors were significantly associated with failure of the fistula. The ones with a hazard ratio (HR) for failure greater than 2.5 were: the start of dialysis before creation of the fistula (HR 2.79, p < 0.01), moderate or poor quality of both the artery (HR 2.54, p < 0.01) and vein (HR 3.55, p < 0.001), and postoperative use of acenocoumarol instead of acetylsalicylic acid (HR 3.14. p < 0.01).


CONCLUSIONS
The major determinants for a successfully created Brescia-Cimino fistula were creation of the fistula before the start of dialysis, as well as good quality of both the artery and the vein. This argues for timely creation of such fistulas in patients with end-stage renal disease and for accurate preoperative examination to establish the quality of the vessels.
Zeebregts
Clark
C
Department of Surgery, University Hospital Groningen, The Netherlands. c.zeebregts@hotmail.com
van den Dungen
Jan
J
Bolt
Arjen
A
Franssen
Casper
C
Verhoeven
Eric
E
van Schilfgaarde
Reinout
R
D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D017211:Treatment Failure; D014654:Vascular Patency