Factors Influencing on Early Patency Rate of Autogenous Arteriovenous Fistula for Hemodialysis / 대한흉부외과학회지

BACKGROUND: It is very important for hemodialysis in patients with end stage renal disease to obtain vascular access that resists repeated punctures and maintains adequate blood flow. This study was designed to indentify factors that may influence early patency rate of autogenous arteriovenous fistula. MATERIAL AND METHOD: 49 cases in 47 patients who underwent radiocephalic fistula formation in our hospital from June 2002 through May 2003 were reviewed and analyzed. RESULT: The early patency rate was 79.6%. Age, sex, hypertension, and diabetes mellitus were not significant factors for patency. Body mass index and duration of hypertension and diabetes did not influence the early results either. Cephalic vein diameter measured preoperatively and blood flow at radiocephalic fistula were significantly positive correlative factors. Groups with the vein diameter less than 2.7 mm, or with the blood flow less than 100 mL/min had significantly lower early patency rate than the other groups. CONCLUSION: To improve early patency rate of radiocephalic fistula, large sized cephalic vein should be selected and if the intraoperative flow at radiocephalic fistula is less than 100 mL/min, another arteriovenous fistula formation should be considered.

Creation of an Axillary Arteriovenous Fistula in Patients with the Pulmonary Arteriovenous Fistula after a Bidirectional Cavopulmonary Shunt: 2 cases / 대한흉부외과학회지

Creation of an axillary arteriovenous fistula (AVF) was performed in two patients with high risks of Fontan operation after a cavopulmonary shunt. The patients complained of progressive cyanosis and decrease in exercise tolerance, and they showed pulmonary arteriovenous fistula on the pulmonary angiography. They were uneventfully transferred to the general ward on the first postoperative day and discharged 3 and 4 days after the operation respectively. There was no evidence of fistula-related volume loading and the other postoperative complications. An 8-month follow-up revealed improved symptoms such as, cyanosis and exercise intolerance, but not sufficient regression of pulmonary arteriovenous fistula on a lung perfusion scan and contrast echocardiography, which should be carefully checked hereafter.

Clinical Analysis of Arteriovenous Fistulas for Hemodialysis / 대한흉부외과학회지

BACKGROUND: Proper construction of vascular access and adequate maintenance are essential for the prognosis of the hemodialysis patients. Though arteriovenous fistula using autogenous vessel is the first of choice, the incidence of arteriovenous fistula using artificial graft is gradually increasing. The aim of this study was to analyse the patency rates between autogenous and artificial fistula, among artificial graft types, according to the accompanied disease. MATERIAL AND METHOD: A retrospective study was conducted on 186 patients who underwent 292 arteriovenous fistula operations for hemodialysis at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 54.37+/-12.89years, and the male: female ratio 99:87. RESULT: Among 292 operations, there were 156 autogenous fistula and 116 graft fistula. The other 20 operations were thrombectomy, takedown of graft, revision, and balloon dilatation. Patency rates of autogenous fistula were 92.78+/-2.35% at 1 year and 39.03+/-9.08% at 5 years, and those of graft fistula were 96.09+/-2.22% at 1 year and 16.45+/-10.15% at 5 years. However, there was no statistical significance between the two operations. The patients who had hypertension, diabetes or both had no statistical significance in the patency rate compared to that of patients without underlying disease. In addition, the type of graft used did not affect the patency rate. Second operation was needed in 62 patients and third operation in 31 patients, but their patency rate again had no statistical significance compared to that of the first operation. CONCLUSION: The patency of the artificial graft fistula was comparable to the autogenous fistula, but the patency according to types of graft need to be studied further. Furthermore, the underlying diseases did not affect the fistula patency.