Abstract
Advances in dialysis have increased the number of cases of secondary arteriovenous fistulas (AVF), advanced arteriosclerosis, and intractable vascular access trouble (VAT). Among patients with existing forearm access points, we compared arteriovenous anastomosis sites, vascular access patency rates, and the frequency of VAT between a transposed basilic vein (TBV)-brachial artery AVF group (Group I) and a TBV-radial artery/ulnar artery AVF group (Group II), in order to re-evaluate the optimal surgical method for secondary AVF. The study population comprised 151 patients with confirmed access loss who had been followed-up for at least 3 months (Group I: 96 patients, Group II: 55 patients). The mean duration of the follow-up period was 37 months. In Group I, the primary patency rate was 40% and 24.7% at 1 and 2 years after the procedure, respectively, while the secondary patency rate was 91.7% and 85.2% at 1 and 2 years, respectively. In Group II, the primary patency rate was 39.5% and 28.5% at 1 and 2 years, respectively, while the secondary patency rate was 92.4% and 87.1% at 1 and 2 years, respectively. Although the frequency of VAT, which was defined as an event that required percutaneous transluminal angioplasty (PTA), was high (86.5% in Group I and 83.6% in Group II), there was no difference between the two groups in either patency rates or the frequency of VAT. Due to the efficacy of PTA, we were able to maintain 5-year secondary patency rates of approximately 80% in both groups.
