Primary vascular access surgery in a well defined geographical region: long-term results of autogenous arteriovenous fistulas.
OBJECTIVE
Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland.


METHODS
All primary vascular access procedures between 1990-1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success


RESULTS
407 primary procedures were done during the 10-year period including 405 (99.5%) autogenous fistulas and two prosthetic grafts (0.5%). 230 (56.8%) fistulas were used for haemodialysis during the study. Cumulative primary functional patency at one year was 84.1%, at two years 75.2% and at five years 50.1%. An attempt to salvage a failing or failed fistula was done in only 15 (6.5%) cases with insignificant impact on outcome. None of the tested variables was associated with poor functional success.


CONCLUSIONS
The strategy of using native radio-cephalic fistula as a first access site results in excellent early and long-term functional patency for ESRD patient.
Department of surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland. velipekka.suominen@ksshp.fi
V
V
Suominen
M
M
Heikkinen
J
J
Saarinen
R
R
Zeitlin
O
O
Wirta
J
J
Salenius
D002408:Catheters, Indwelling; D005260:Female; D005387:Finland; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies