Clinical Experience with Internal Arteriovenous Fistula Formation

Cho, Lae Hyeok; Yu, Hee Chul; Jung, Sung Hoo; Cho, Baik Hwan

Abstract

BACKGROUNDS: Hemodialysis remains the most important support for patients with end stage renal disease, and reliable vascular access is an essential component for their life. The internal arteriovenous fistula (AVF) fulfills nearly all of the criteria for an optimal access for chronic hemodialysis, such as long-term patency rate, low complication rate.
OBJECTIVE
This retrospective study is to review our experience and to evaluate the patency rate and the influencing factors of graft failure of the AVF. MATERIAL AND METHODS: From May 1988 through January 1997, 251 fistulas were created of 243 patients in Chonbuk National University Hospital. Only 119 cases were able to follow up survey. The statistical analysis used by Chi-square and Kaplan-Meier method.
RESULTS
The male versus female ratio was 1.3:1 and the age distribution was occurred on from 3rd decade to 7th decade (93%). The most common cause of renal failure was hypertension and diabetes (54 cases, 45.4%). Among the 119 cases, the autogenous graft fistulas were performed in 106 cases (wrist/snuff box/antecubital fossa, 94/7/5), PTFE graft fistulas were 13 cases. The autogenous graft failures were 28 cases (early/late 15/13), PTFE graft failures were 8 cases (early/late 5/3). Overall failures, the most common cause was thrombosis or stricture (41.6%), and then dysfunction, infection, dysperfusion, rupture, and aneurysm in order of frequency. Early failures were occurred in 20 patients (male/female, 15/5) and late failures in 16 patients (male/female, 3/13). Older age (over 50 years old) and PTFE graft were more higher failure rate than younger age and autogenous fistula. 12, 24, 36 months accumulated patency rates were 70, 62, 55%, retrospectively.
CONCLUSIONS
The results suggest that early failure was more frequent in male, and late failure was more frequent in female. The significant influencing factors of graft failures were age and material, one is PTFE graft and the other is over 50 years old were higher failure rate.