title: Preserving arteriovenous fistula outcomes during surgical training.
abstract: OBJECTIVE
  Arteriovenous fistulae (AVFs) are the preferred option for vascular access, as they are associated with lower mortality in hemodialysis patients than in those patients with arteriovenous grafts (AVGs) or central venous catheters (CVCs). We sought to assess whether vascular access outcomes for surgical trainees are comparable to fully trained surgeons.
  
  
  METHODS
  A prospectively collected database of patients was created and information recorded regarding patient demographics, past medical history, preoperative investigations, grade of operating surgeon, type of AVF formed, primary AVF function, cumulative AVF survival and functional patency.
  
  
  RESULTS
  One hundred and sixty-two patients were identified as having had vascular access procedures during the 6 month study period and 143 were included in the final analysis. Secondary AVF patency was established in 123 (86%) of these AVFs and 89 (62.2%) were used for dialysis. There was no significant difference in survival of AVFs according to training status of surgeon (log rank x2 0.506 p=0.477) or type of AVF (log rank x2 0.341 p=0.559). Patency rates of successful AVFs at 1 and 2 years were 60.9% and 47.9%, respectively.
  
  
  CONCLUSIONS
  We have demonstrated in this prospective study that there are no significant differences in outcomes of primary AVFs formed by fully trained surgeons versus surgical trainees. Creation of a primary AVF represents an excellent training platform for intermediate stage surgeons across general and vascular surgical specialties.
authors.affiliation: 1 Department of Vascular Access and Renal Transplantation, University Hospitals Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham - UK.
authors.forename: Damian G
authors.initials: DG
authors.lastname: McGrogan
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Inston
authors.forename: Hari
authors.initials: H
authors.lastname: Krishnan
authors.forename: Mel
authors.initials: M
authors.lastname: Field
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000193:education*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency