Snuffbox Arteriovenous Fistula Formation for Hemodialysis

Seo, Pil Won; Ryu, Jae Wook; Park, Jeong Ok; Chang, Sung Wook; Kim, Mi Soon; Park, Seong Sik; Kim, Sam Hyun

Abstract

BACKGROUND: The arteriovenous fistula (AVF), which maintains satisfactory blood flow, is necessary to the patients of end-stage renal disease for the long term hemodialysis. We performed the snuffbox fistula as the first operation for hemodialysis vascular access. This study was performed to investigate the patency rates, complications, risk factors for occlusion of the AVF, and the types of reoperations. MATERIAL AND METHOD: We performed 146 snuffbox fistulas from Jun. 1994 to Dec. 2001. The records of the patients except six patients who were lost from follow up were analyzed retrospectively. Mean age and male:female ratio were 52+/-15 years (range, 17~79 years) and 80:60 respectively. Diabetes mellitus and hypertension were combined in 47 patients and 101 respectively. Preoperative levels of creatinine and potassium were 9.09+/-3.68 mg/dL (range, 2.55~20.09 mg/dL) and 4.7+/-0.9 mmol/L (range, 2.3~8.1 mmol/L). One hundred thirteen cases of the snuffbox fistulas were done at left side hand and the others at right hand. RESULT: Mean follow up period of the patients was 41.8+/-31.0 months (range, 0.2~108.8 months). During the follow up period, 35 occlusions of AVF occurred and these AVFs were patent for 9.8+/-10.1 months (range, 0.1~40.4 months). The patency rates of 1 month, and 1, 2, 3, 5 years were known as 92.8, 80.2, 73.8, 71.3, 69.6% respectively. Right sided snuffbox fistulas (p-value=0.045) and old age (p-value=0.048) were revealed as significant risk factors for occlusion of AVF. The postoperative complications consisted of occlusions of AVF caused by intimal hyperplasia of vein in 24, thrombosis in nine, stenosis of anastomosis site in three, and venous hypertensions in two. After the first operation 37 patients underwent 86 reoperations.
CONCLUSION
The snuffbox fistulas showed acceptable patency rates and low complication rates. The snuffbox fistulas as the first operation for AVF formation can be a good option for the patients with end-stage renal disease.