Fistula elevation procedure: experience with 295 consecutive cases during a 7-year period.
BACKGROUND
Up to 50% of AV fistulas fail to mature, primarily because of problems with fistula cannulation. Fistula elevation procedure (FEP) is a simple superficialization procedure where the fistula is surgically exposed, mobilized, and elevated into a more superficial position for the purpose of facilitating AV fistula cannulation. The purpose of this study is to review use of FEP as an adjunct to fistula maturation.


METHODS
Two hundred ninety-five FEPs were performed between February 1999 and December 2005. FEP was performed if the fistula was considered too deep to cannulate or if nurses were unable to cannulate the fistula. Kaplan-Meier life-table analysis was used to determine patency and for a subanalysis by location of FEP performed (172 brachial-cephalic, 70 brachial-basilic, 46 radial-cephalic, 7 superficial femoral vein). Survival curves were compared using log-rank test.


RESULTS
Functional primary patency rates for patients undergoing an adjunctive FEP were 73% at 6 months, 60% at 1 year, and 46% at 2 years. Secondary functional patency rates were 81% at 6 months, 71% at 1 year, and 59% at 2 years. There was no statistical significance in any outcomes based on anatomic site of elevation.


CONCLUSIONS
AV fistulas that might otherwise have been abandoned because of excessive depth or tortuosity can be successfully salvaged by an adjunctive FEP and achieve satisfactory longterm functional patency. FEP is a valuable adjunct to AV fistula creation, which will enhance fistula maturation rates.
Bronder
Cathy M
CM
Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA.
Cull
David L
DL
Kuper
Spencer G
SG
Carsten
Christopher G
CG
Kalbaugh
Corey A
CA
Cass
Anna
A
Watkins
Tina
T
Taylor
Spence M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007866:Leg; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012086:Reoperation; D016896:Treatment Outcome; D014654:Vascular Patency