Abstract
Prolonged survival of vascular access is vital to trouble free dialysis. This study was designed to determine the factors affecting the patency of the vascular access. We reviewed our experience with 975 vascular access procedures (364 autogenous internal A-V fistulae, 211 PTFE internal A-V fistulae, 260 autogenous external shunts, 138 PTFE external shunts) in 316 chronic hemodialysis patients.
Whereas the cumulative patency rate for autogenous internal A-V fistulae was 65% at 3 years and 57% at 5 years, the patency rate for PTFE internal A-V fistulae was 31% at 3 years and 21% at 5 years. Autogenous internal A-V fistulae thus retained a significantly higher patency rate compared with PTFE internal A-V fistulae (p<0.001). Autogenous external shunts and PTFE external shunts had extremely poor results; patency rates were similar and about 20% at 1 year and about 10% at 2 years. We statistically analyzed the following variables; sex, age, causes of renal failure, diabetes mellitus, hypertension, hyperlipidemia, hematocrit and site of anastomosis. Multivariate analysis proved significantly poorer patency in older patients for autogenous internal A-V fistulae (p<0.01), and in patients with hyperlipidemia (p<0.01) or diabetic nephropathy (p<0.05) for PTFE internal A-V fistulae. Patients with more than 2 risk factors had a significantly worse patency rate for PTFE internal A-V fistulae compared with patients with less than 1 risk factor.
It has been definitely shown by this study that age, hyperlipidemia and diabetic nephroathy worsen the patency of vascular access. This study also suggests that the other factors may also affect the patency of PTFE internal A-V fistulae.
