title: The middle arm arteriovenous fistula is an additional option to expand autogenous hemodialysis access.
abstract: OBJECTIVE
  The native arteriovenous fistula is the gold standard for hemodialysis access. Unfortunately, the wrist fistula is often not practical and the upper arm fistula is hindered by several complications. The aim of this study is to assess the safety of the middle-arm fistula as additional native access.
  
  
  METHODS
  We reviewed and compared the patency rates at 12, 48, and 60 months of distal, middle, and upper arm fistula performed from January 2003 to December 2008. For diabetic and old patients we compared distal and middle-arm fistulas.
  
  
  RESULTS
  Of 273 native access, 149 (54.6%) were distal, 92 (33.7%) middle-arm, and 32 (11.7%) upper fistula. Patency rates were 81%, 58%, and 52% for distal, 85%, 69%, and 69% for middle-arm, and 82%, 46%, and 29% for upper arm fistula (P NS). Patency rates were 92%, 70%, and 54% in middle-arm fistula as first access and 80%, 71%, and 71% in middle-arm fistula as a rescue access (P NS). Among patients > 75 years patency rates were 78%, 62%, and 62% for distal and 87%, 67%, and 67% for middle-arm fistula. Among diabetic subjects patency rates were 81%, 58%, and 58% for middle-arm and 65%, 57%, and 57% for distal fistula at 12, 48, and 60 months (P NS) respectively.
  
  
  CONCLUSIONS
  A middle-arm fistula is as safe as a distal fistula among dialyzed patients, even diabetic and elderly. This could be considered a reliable option to expand native accesses.
authors.affiliation: Nephrology and Dialysis Unit, Maggiore della Carità Hospital, Novara, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Capurro
authors.forename: Andreana
authors.initials: A
authors.lastname: De Mauri
authors.forename: Carlo
authors.initials: C
authors.lastname: Navino
authors.forename: Paola
authors.initials: P
authors.lastname: David
authors.forename: Doriana
authors.initials: D
authors.lastname: Chiarinotti
authors.forename: Martino
authors.initials: M
authors.lastname: De Leo
mesh_terms: D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency