Risk Factors Affecting the Patency Rate after Arteriovenous Fistula Creation for Hemodialysis

ABSTRACT

PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of arteriovenous fistula (AVF) for maintenance hemodialysis. METHODS: From March 1997 to April 1999, a total of 206 AVF creation operations [126 of radiocephalic fistula (RCF), 59 of brachiocephalic fistula (BCF), and 21 of grafted fistula] in 165 patients were undertaken by single surgeon under the same surgical technique and principles. In 128 cases (62.1%), operation was performed for the first time and in 42 cases (20.4%), the trial was second time. However in remaining 36 cases (17.5%), the operation was three or more than three times. RESULTS: After a mean follow-up of 9 months, 27 patient death and 53 fistula failure were identified. The overall patency rate at 1- and 2-year were 72.6% and 61.1%. The success patency rate, excluding the early failure cases, at 1-and 2-year were 78.4% and 65.9%. In multivariate analysis, the presence of 2 or more than 2 times failed AVF episodes was the significant risk factor forecasting the poor fistula patency (p0.05). In univariate analysis, the 1- and 2 year patency rate of more than third AVF trial group were 53.2% and 25.3%, which showed significant poor patency rate comparing with the ones of first or second AVF trial group (76.73% in 1- and 67.9% in 2-year) (p=0.0197). CONCLUSION: In conclusion, repeated trial of AVF creation (= or >3) in itself was the most powerful significant risk factor affecting the patency rate after AVF creation. The successful first or second trial is very important to expect a long-term patency. Well designed surgery under delicate surgical technique in early referred patient should promise the long-term patency even in patients with diabetes or patients requiring grafted fistula.