Abstract
The purpose of this study is to examine the long term results of hemodialysis access placement and maintenance procedures in order to clarify the most effective strategy for maintaining the functional access over long periods of time. Of patients who underwent hemodialysis access procedure in our facility in the 23 years dating from December 1984 to November 2007, long term follow-up data was available for 1895 patients that were involved in the study. Hemodialysis access procedures using autogenous conduits were performed on 1560 patients (82.3%), whereas prosthetic conduits were used on 114 patients (6.0%). Percutaneous transluminal angioplasty was performed on 221 patients (11.7%). The 1, 3, and 5 year secondary patency rates for each modality were as follows: snuff box arteriovenous fistula (AVF) 61, 53, 44%; Brescia-Cimino AVF 70, 59, 54; radial-cephalic direct forearm access 78, 69, 58; antecubital brachial-cephalic AVF 87, 72, 55; prosthetic forearm loop access 59, 39, 24; prosthetic upper arm loop access 63, 36, 27; patch angioplasty 64, 64, 53; PTA 59, 49, 46. The best 3 year secondary patency rate was the 87.6% which was seen in upper arm vein transposition coupled with antecubital AVF procedure. Thrombosis of the fistula peaked at two different periods; the first 2 years following the operations and re-emerges after the 10-year mark. Postoperative surveillance should be focused on these periods. Excellent results of procedures using autogenous vessels, including deep vein transposition, encourage more use of these conduits in vascular access procedures.
