title: Fistula first, graft on arterialized vein second.
abstract: OBJECTIVE
  Arterovenous grafts (AVGs) present a feasible solution for creating a vascular access in patients who are unsuitable for autogenous fistula (AVF). The aim of this study is to assess the prevention rate of vein stenosis, placing a graft on an arterialized vein (GAV) instead of an anastomized AVG in a native vein (GNV).
  
  
  METHODS
  This was a cohort study conducted from January 2009 to November 2012. All consecutive patients who underwent AVG in our institution were included. All patients requiring a secondary intervention were also referred to our centre. Patients underwent ultrasound follow up at first and the every month. A Kaplan-Meier method was used; a Log-rank test was used to identify whether significant difference existed between GAV and GNV (p < 0.05).
  
  
  RESULTS
  Forty-six grafts were placed. Twenty patients had arterialized receiving veins (group A), while 26 patients received an AVG immediately because they lacked autogenous veins suitable for fistula (group B).The average follow-up period was 16.1 months (range 0-41). The group A 41 months-patency rate was 84.3%, while group B was 43.7% (p = 0.06). Secondary patency was similar in the two groups.
  
  
  CONCLUSIONS
  Vein arterialization seems to prevent venous stenosis improving AVG-patency rate. More data are needed; however, the borderline p value encourages new studies.
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy galzerano.giuseppe@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galzerano
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Giubbolini
authors.affiliation: Department of Surgery "P. Valdoni", Sapienza University of Rome, Roma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
authors.forename: Gianmarco
authors.initials: G
authors.lastname: de Donato
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
authors.forename: Pasqualino
authors.initials: P
authors.lastname: Sirignano
authors.affiliation: Departement of Molecular and Development Medicine, University of Siena, Siena, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Messina
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappelli
authors.affiliation: Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005402:Fistula / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*
keywords: Fistula; arterovenous graft; haemodialytic conduits; patency