title: Natural history of upper limb arterio-venous fistulae for chronic hemodialysis.
abstract: OBJECTIVE
  Arterio-venous fistulae (AVF) for hemodialysis are prone to problems, ultimately leading to failure of the fistulae. Our aim was to determine the site and time to first stenosis and time to and factors influencing AVF failure for radio-cephalic (RC), brachio-cephalic (BC), and transposed brachio-basilic (BB) AVF.
  
  
  METHODS
  Retrospective analysis of native AVF constructed within a single vascular unit between January 2002-December 2008. Patients followed up to the end points of death, AVF failure or end of study period. Data collected included: age, sex, AVF type, time and site of first stenosis and time to failure. The relationship between fistula type, stenosis, and failure were examined.
  
  
  RESULTS
  In total, 398 native AVF were included in the study (91 RC, 208 BC, and 99 BB), with a mean age of 66 years. A total of 215 (54%) AVF developed a flow limiting stenosis, and over time 151 (40%) AVF failed. Stenoses developed significantly earlier in RC AVF (median 113 days) compared to BC (median 277 days), compared to BB (median days 414), P=.029. There was no statistically significant difference in time to failure (RC median 1344 days; BC median 1576 days; BB median 1159 days), P=.673. The presence of stenosis was the only variable found to have a significant impact on AVF failure in multivariate analysis.
  
  
  CONCLUSIONS
  Type of upper limb fistula did not impact on failure rates. Flow limiting stenoses impacted on fistula failure.
authors.affiliation: Department of Vascular Surgery/East of Scotland Vascular Network, Ninewells Hospital, Dundee, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Suttie
authors.forename: Geeta
authors.initials: G
authors.lastname: Ponnuvelu
authors.forename: Nikola
authors.initials: N
authors.lastname: Henderson
authors.forename: Ross
authors.initials: R
authors.lastname: Vint
authors.forename: Rose
authors.initials: R
authors.lastname: Ross
authors.forename: Ruth
authors.initials: R
authors.lastname: Tootill
authors.forename: Alison
authors.initials: A
authors.lastname: Howd
authors.forename: Janos
authors.initials: J
authors.lastname: Nagy
authors.forename: Gareth D
authors.initials: GD
authors.lastname: Griffiths
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland; D013997:Time Factors; D017211:Treatment Failure; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000601:surgery