Determinants of failure of brachiocephalic elbow fistulas for haemodialysis.
OBJECTIVE
The aim of this study was to analyse the results of brachiocephalic fistulas for haemodialysis and to determine possible predictors of failure.


METHODS
Between April 1999 and September 2004, a consecutive series of 100 autologous brachiocephalic fistulas were created in 96 patients. There were 57 men and 39 women with a mean (SD) age of 59.2 (15.6) years. Data were prospectively gathered.


RESULTS
The mean (SD) follow-up was 20.1 (16.4) months. The primary, primary assisted, and secondary patency rates after 6 months were 73.4, 83.2 and 86.4%, respectively. After 1 year, these figures were 54.7, 72.3 and 79.2%, and after 2 years 40.4, 59.2 and 67.5%, respectively. Predictors of failure with regard to primary patency, determined with Cox regression multivariate analysis, included diabetes mellitus (HR 2.81, p < 0.001) and a history of contralateral PTFE loop graft (HR 7.79, p = 0.007).


CONCLUSIONS
Primary patency of brachiocephalic fistulas is comparable to that of radiocephalic fistulas. Primary assisted and secondary patency rates can, however, be brought to a much higher level, especially in patients without diabetes and a large-diameter venous outflow tract.
Zeebregts
C J
CJ
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands. czeebregts@hotmail.com
Tielliu
I F J
IF
Hulsebos
R G
RG
de Bruin
C
C
Verhoeven
E L G
EL
Huisman
R M
RM
van den Dungen
J J A M
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D016122:Brachiocephalic Trunk / Q000601:surgery*; D016121:Brachiocephalic Veins / Q000601:surgery*; D004550:Elbow / Q000098:blood supply / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy*; D012307:Risk Factors; D017211:Treatment Failure; D014654:Vascular Patency