A Clinical Results of Prosthesic Arteriovenous Fistulas

Abstract

There have been 22 cases (23 limbs) of constructed prosthesis arteriovenous fistulas (PAVF) in our department since January 1996. The average age of the recipients was 67.7 ± 9.50 years old and included 8 male and 14 female patients. The causes of introduction of hemodialysis were diabetic nephropathy in 8 patients, chronic glomerulonephritis in 2, tuberculosis nephrophthisis in 2, nephrectomy in 2, and unknown in 8.6-mm-diameter ePTFE graft was used in all cases. The site of the PAVF was the forearm in 6 patients (all left limb), the upper arm in 16 (right 3, left 13) and the neck in 1. The causes of PAVF failure were stenosis or obstruction at the venous side of arteriovenous fistula (AVF) in 6 cases, stenosis of vein anastomosis in one, and infection of the prosthesis in one. Obstruction of the subclavian or axillary vein occurred in 3 cases (4 sites). In venous stenosis/obstruction cases, two patients underwent a jump bypass of a stenosis segment and two patients underwent thrombectomy and percutaneous transluminal angioplasty (PTA). Stenosis of the vein anastomosis repaired the site. In the case with an infection of the prosthesis, the prosthesis was removed and then a PAVF was constructed on the opposite arm. The subclavian vein or axillary vein was obstructed in 3 cases (4 sites). An axillo-axillary vein bypass was performed in 2 patients, a brachio-carotid vein bypass was performed in one and an axillo-carotid vein bypass was performed in one. Eight-mm ePTFE prosthesis was used in all bypasses. Two died 3 and 16 months after the operation, respectively. Two grafts were obstructed 12 and 24 months after bypass grafting, respectively. The primary patency rate of the PAVF was 68% for one year and 25% for three years. The cumulative survival rate of the cases was 66.6% for one year and 32.9% for three years. Because of the poor prognosis of patients receiving PAVFs, it is important to minimize invasive repairs according to the cause of PAVF failure other than the long-term patency.