ABSTRACT
A comprehensive review of vascular access procedures at one institution over a 10-year period was performed to assess primary hemodialysis (HD) access patency. A total of 427 operations were performed between January 1983 and January 1993. There were 147 Brescia-Cimino fistulae (B-C fistula), 111 perforating antecubital vein (PAV) fistulae, and 28 synthetic graft fistulae. There were 134 patients who were not considered candidates for arteriovenous fistula (AVF) formation and received only central venous HD access. Seven external fistulae in burn patients were deleted from the study. No patient in this study had undergone prior HD access. Primary failure was defined as fistula thrombosis, inadequate flow for hemodialysis, or a complication requiring ligation. Kaplan-Meyer life table analysis was used to determine primary fistula patency. The results were as follows: PAV fistulae had a primary patency rate of 80% at a median follow up of 36 months (1-124 months); the B-C fistula was 66% at a median 27 months (1-120 months), and the synthetic graft fistula was 64% at median 7 months (1-40 months). The primary patency rate of the PAV fistula was significantly better than the B-C fistula (p = 0.0015) or the synthetic graft fistula (p = < 0.0001). In conclusion, the PAV fistula has an excellent patency rate and appears to be a viable option for AV access after a failed B-C fistula or when a B-C fistula is not technically feasible.