Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency.
BACKGROUND
The provision and maintenance of vascular access remains a major cost to end-stage renal failure programs. In addition, vascular access occlusion, results in significant morbidity in hemodialysis patients. Age, gender, diabetes mellitus, malignancy, smoking habits, administration of heparin per hemodialysis session, previous dialysis catheter insertion, number of hemodialysis sessions and location of the fistula may be associated with survival of the primary arteriovenous fistula. We examined the effects of various factors on fistulas in 412 chronic renal insufficiency patients.


METHODS
From 1995 to 2004, 412 arteriovenous fistulas were created by the Department of Cardiovascular Surgery at the Medical Faculty of Atatürk University for hemodialysis. The mean age of the patients was 45 years (range 6 to 62 years). We evaluated the effects of various factors for patency rates in the patients who had primary arteriovenous fistulas. Primary patency was defined as the duration of fistula patency without revision. Twenty-eight patients (6.7%) with ischemic cardiac disease did not require surgical interference. Analyzed data were age, gender, smoking habits, diabetes mellitus, malignant neoplasm, previous dialysis catheter insertion, number of hemodialysis sessions, and fistula location.


RESULTS
In 298 patients, where lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively, in the other 114 patients, where upper-arm fistulas were created, these rates were 84.0%, 72.2%, 53.3%, 39.8%, and 12.3%, respectively. There was no significantly difference between the upper-arm fistulas and the lower-arm fistulas statistically (p = 0.069). Factors affecting the primary patency of arteriovenous fistulas were diabetes mellitus (p = 0.0001), hemodialysis counts > or =3 per week (p < 0.0005), presence of malignancy (p < 0.0005), previous catheter insertion (p < 0.0007), and administration of heparin per hemodialysis session (p = 0.0008).


CONCLUSIONS
While primary arteriovenous fistula patency was shortened in chronic renal insufficiency patients with diabetes mellitus, presence of malignancy, and previous catheter insertion, patency was longer in patients with heparin used for hemodialysis and hemodialysis count per week (> or =3).
Erkut
Bilgehan
B
Department of Cardiovascular Surgery, Atattürk University Medical Faculty, Erzurum, Turkey. bilgehanerkut@yahoo.com
Unlü
Yahya
Y
Ceviz
Münacettin
M
Becit
Necip
N
Ateş
Azman
A
Colak
Abdurrahim
A
Koçak
Hikmet
H
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D002404:Catheterization; D002648:Child; D003920:Diabetes Mellitus; D005260:Female; D005542:Forearm / Q000601:surgery; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency
D000925:Anticoagulants; D006493:Heparin