2004 Volume 37 Issue 4 Pages 307-310
The influence of age, gender, original disease and the region of internal shunt placement on cumulative patency rate and surgical time was investigated in 140 patients who were newly introduced to hemodialysis and received the first internal shunt procedure between 1992 and 2001 at our hospital. The mean patients age was 60.2 years, and there were 86 males and 54 females. Sixty-seven patients had diabetic nephropathy and 56 chronic glomerulonephritis. The internal shunt was placed in the snuff-box (tabatiere) in 80 patients, and in the cephalic vein of the forearm in 60 patients. The cumulative patency rate of internal shunt 1, 3, 5 and 10 years after surgery was 75.7%, 71.0%, 69.0%, and 60.5%, respectively. When comparing the cumulative patency rate by age, gender, region of internal shunt placement, and presence of diabetes mellitus, there was a significant difference in patency between patients aged 60 years or older and those younger than 6 years, and between males and females. The mean surgical time was 96.3 minutes. The surgical time for the snuff-box (88.8 minutes) was significantly shorter than that for the forearm (107.8 minutes). There was no difference in the patency period between the snuff-box procedure and that for the forearm. Intra- and post- operative management should be performed carefully for females and elderly patients, since the risk of shunt occlusion was higher in these patients compared with that in males and younger patients, respectively. Shunt surgery by the snuffbox technique required a shorter surgical time, and might have an advantage in conserving the forearm vessels.
