title: A 5-year audit of haemodialysis access.
abstract: This is a review of our experience with vascular access procedures over a 5-year period at Derriford Hospital, Plymouth, UK. The aims of the study were to examine the outcome of vascular access procedures and factors influencing access survival. Between April 1995 and March 2000, 151 patients who underwent 221 vascular access procedures were studied. Of these, 136 had autogenous arteriovenous fistulae, whereas 85 had prosthetic AV grafts (41% in the thigh). The overall primary failure rate was 21% whereas the 1- and 5-year cumulative access survival rates were 60 and 41%, respectively. Thigh grafts have a mean survival of 36 months compared with 32 months for prosthetic upper limb and 43 months for autogenous fistulae. Age, diabetes and predialysis status did not significantly influence access survival. Thrombosis was responsible for access failure in 62 cases (28%). Avoiding subclavian vein canulation and performing vessel mapping prior to access placement should reduce the risk of access failure due to outflow obstruction.
authors.affiliation: Department of Renal Medicine, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK. jacob.akoh@phnt.swest.nhs.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Akoh
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: S
authors.initials: S
authors.lastname: Dutta
authors.forename: A S
authors.initials: AS
authors.lastname: Opaluwa
authors.forename: H
authors.initials: H
authors.lastname: Lawson
authors.forename: J F
authors.initials: JF
authors.lastname: Shaw
authors.forename: A J
authors.initials: AJ
authors.lastname: Walker
authors.forename: P A
authors.initials: PA
authors.lastname: Rowe
authors.forename: R J
authors.initials: RJ
authors.lastname: McGonigle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy*; D008297:Male; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology