title: Prospective evaluation of failure modes in autogenous radiocephalic wrist access for haemodialysis.
abstract: BACKGROUND
  Radiocephalic wrist arteriovenous fistulae (RCAVF) are the primary and best option for vascular access for haemodialysis treatment. However, 10-24% of these AVFs fail due directly to thrombosis and non-maturation. In a prospective study, the failure modes of radiocephalic AVFs and the impact of surgical and interventional treatment on fistula outcome were investigated.
  
  
  METHODS
  The rate of thrombosis and non-maturation was evaluated in 43 RCAVFs. The selection of RCAVF creation was made on preoperatively determined duplex parameters. Fistula function was evaluated post-operatively by clinical examination and non-invasively measured AVF blood flow. A policy of a liberal use of radiological and/or surgical revision of non-functioning RCAVFs was made on the basis of duplex measured blood flow and angiographically detected vessel stenosis.
  
  
  RESULTS
  Primary fistula function was achieved in 26 of 43 patients (60%). Non-maturation and thrombosis occurred in 14 (33%) and three (7%) patients, respectively. A total of 12 interventions (PTA 6; surgery 6) were needed, resulting in salvage of eight RCAVFs (47%). The blood flow in functioning AVFs was significantly higher compared to non-functioning AVFs at 1 (754 vs 440 cc/min), 7 (799 vs 524 cc/min) and 42 days (946 vs 532 cc/min) post-operatively. At the end, 34 RCAVFs (79%) became functional as vascular access for haemodialysis treatment.
  
  
  CONCLUSIONS
  Primary RCAVFs have a high rate of failure. An aggressive approach towards early interventional treatment of these non-functional AVFs is worthwhile and leads to a considerable salvage rate. Early post-operative AVF flow measurement indicates the chance of successful maturation of RCAVF.
authors.affiliation: Department of Surgery, University Hospital Maastricht, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands. j.tordoir@surgery.azm.nl
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Tordoir
authors.forename: Patrick
authors.initials: P
authors.lastname: Rooyens
authors.forename: Ruben
authors.initials: R
authors.lastname: Dammers
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Michiel
authors.initials: M
authors.lastname: de Haan
authors.forename: Tik Ien
authors.initials: TI
authors.lastname: Yo
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery*; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012086:Reoperation; D016879:Salvage Therapy; D013927:Thrombosis / Q000209:etiology; D017211:Treatment Failure; D014680:Veins / Q000601:surgery