Creation of permanent hemodialysis vascular access in patients with failed arteriovenous fistula.
OBJECTIVE
To compare the patency rate and complications of arteriovenous fistula (AVF) with synthetic graft in patients with previous history of failed AVF.


METHODS
This study was carried out at Sina Hospital, Tehran, Iran from April 2002 to July 2003. Patients who had been referred to our center with previous failed attempt for creation of AVF were collected. We again tried to create an AVF in some of these patients according to physical examination and clinical judgment of the vascular surgeon. A synthetic graft was inserted for the remainder of the patients. All patients were followed up for 3 months.


RESULTS
Elbow fistula placement was possible in 43% of patients including half of patients with diabetes and half of those more than 65 years old. Failure occurred in 33% of grafts versus 19% of fistulas. The complications were venous hypertension in one case and infection in 2 cases, all from the graft group.


CONCLUSIONS
Our results show lower failure, mortality, and complication in AVFs than the synthetic graft, similar to previous reports. However, there were some limitations such as small sample of patients and short duration of follow up in our study. We suggest that AVF is an option even in patients who had previous multiple procedures with the advantage of being cost-effective, and with fewer complications. However, we cannot conclude any superiority for one method, as it is not a properly designed comparative trial.
Moini
Majid
M
Division of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. moinim@hotmail.com
Rasouli
Mohammad R
MR
Rayatzadeh
Hussein
H
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000150:complications; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency