Vascular access outcomes in HIV-positive patients.
OBJECTIVE
There is a limited source of information about vascular access outcomes in HIV-positive patients in the literature. Previous studies have shown autogenous arteriovenous fistulae (AVF) to have similar cumulative survival rates in HIV-positive and negative patients but functional patency has not been assessed. The primary aim of this study was to investigate functional patency of AVFs in HIV-positive patients.


METHODS
A retrospective case-control study identifying 17 HIV-positive patients with AVFs under the care of renal services at Kings College Hospital, London was undertaken. Seventeen HIV-negative controls were matched for age, sex, ethnicity, and co-morbidities. Comparisons were made for pre-operative vein diameter, primary and functional patencies, and post-operative complications.


RESULTS
No statistically significant difference was seen for functional patency between AVFs in the HIV-positive and control groups (P=.078). Complications were experienced by five HIV-positive patients (29.4%) and nine of the control group (52.9%). These included aneurysms and pseudoaneurysms for both groups. The difference in pre-operative vein diameter was not significant (P=.102), although only five of the HIV-positive patients had pre-operative vein diameters >=2.5 mm (45.5%) compared to twelve of the controls (75%).


CONCLUSIONS
This study reveals that there is no statistically significant difference between the functional patency of autogenous AVFs in HIV-positive patients compared to HIV-negative controls. With less than half of the HIV-positive patients having pre-operative vein diameters >=2.5 mm, this suggests that it is still worth creating AVFs in patients with sub-optimal veins considering the known poorer patency with non-autogenous fistulae.
Vascular Surgery, King's College Hospital, London, UK.
Hiren
H
Mistry
Rhiannon
R
Lifford
Matthew A
MA
Stephenson
Domenico
D
Valenti
D016263:AIDS-Associated Nephropathy / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000783:Aneurysm / Q000209:etiology / Q000503:physiopathology; D017541:Aneurysm, False / Q000209:etiology / Q000503:physiopathology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008131:London; D008297:Male; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency