title: Creation of secondary arteriovenous fistulas: maximizing fistulas in prevalent hemodialysis patients.
abstract: National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guideline 29 suggests that a patient should be evaluated for a secondary arteriovenous fistula (AVF) following each episode of dialysis access failure. Regretfully, it does not appear that this approach is used, even though recent data have emphasized that veins suitable for the creation of a secondary AVF can be identified in dialysis patients who are receiving dialysis via a synthetic arteriovenous graft (AVG) or other type of potentially dysfunctional vascular access. In this study nine patients (five with an AVG and four with an AVF) with vascular access dysfunction undergoing percutaneous interventions were evaluated for secondary AVF creation. All were found to have suitable vascular anatomy and had the AVF created. The secondary fistula was successful in all nine patients with a mean follow-up of 4.8 +/- 1.4 months in post-AVG cases and 5.6 +/- 1.7 months in the post-AVF patients. In addition, it was possible to continue uninterrupted dialysis without the use of a tunneled dialysis catheter in three of the patients with AVGs. This experience demonstrates the validity and success of this approach to the management of dialysis access dysfunction. In the ongoing effort to optimize vascular health status, we suggest that during percutaneous interventions, patients should routinely have identification of vessels suitable for creation of a secondary AVF.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. Aasif@med.miami.edu
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Unger
authors.forename: Patricia
authors.initials: P
authors.lastname: Briones
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Gautam
authors.initials: G
authors.lastname: Cherla
authors.forename: Oliver
authors.initials: O
authors.lastname: Lenz
authors.forename: David
authors.initials: D
authors.lastname: Roth
authors.forename: Phillip
authors.initials: P
authors.lastname: Pennell
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000473:pathology / Q000503:physiopathology; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000503:physiopathology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D014654:Vascular Patency; D014680:Veins / Q000473:pathology / Q000503:physiopathology