Arteriovenous fistula reconstruction in patients with kidney allograft failure.
BACKGROUND
Kidney recipients with failing allograft function face the vascular access problem again before returning to hemodialysis. An autologous arteriovenous fistula (AVF), according to the recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, is the optimal vascular access and the use of prosthetic grafts and catheters should be limited. The objective of this study was to assess the feasibility of AVF reconstruction in patients reentering hemodialysis after kidney allograft failure.


METHODS
Two hundred and forty-one transplant recipients reentered hemodialysis between 1990 and 2005. Before kidney transplantation, 221 patients had a functioning AVF on the forearm. Fistula reconstruction was attempted in 112 (51%) patients because of AVF thrombosis. Three strategies were applied according to forearm vein patency: a new radial-cephalic fistula, a radial-perforating vein fistula, or a radial-basilic forearm transposition was created.


RESULTS
Forearm AVFs were successfully reconstructed in 85 of the 112 patients (73%). The primary patency of the reconstructed AVFs was 57.6% and 44% at 12 and 24 months. Secondary patency was 64.9% and 54.9% at 12 and 24 months, respectively.


CONCLUSIONS
The reconstruction of an old, thrombosed AVF is possible in kidney recipients returning to dialysis, even if the time from thrombosis to fistula repair is a few years.
Weyde
Wacław
W
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Letachowicz
Waldemar
W
Krajewska
Magdalena
M
Gołebiowski
Tomasz
T
Letachowicz
Krzysztof
K
Kusztal
Mariusz
M
Porazko
Tomasz
T
Watorek
Ewa
E
Madziarska
Katarzyna
K
Klinger
Marian
M
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005542:Forearm / Q000098:blood supply / Q000601:surgery; D015312:Hemodialysis Solutions / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery; D051437:Renal Insufficiency / Q000601:surgery* / Q000628:therapy*; D012086:Reoperation; D014654:Vascular Patency
D015312:Hemodialysis Solutions