[Surgical experiences with the arteriovenous hemodialysis shunt (1970-1988)].

Data were collected concerning 307 arteriovenous fistula for hemodialysis created in 186 patients between 1970 and 1988 at the Municipal Hospital Waid of Zurich. The average age of all patients was 52.7 years. The procedure which provides access for 97.2% of all patients is the radiocephalic fistula (Cimino-Brescia), which became dilated within 4 weeks in 82.9%. There was a primary failure rate of 11.2%. The patency rate was 60.2% after 3 years and 36.6% after 5 years. Early complications, especially thrombosis, occurred in 11.2% and were caused usually by technical faults or hypotonia. Late complications were discovered in 42.8% of the patients (22.5% thrombosis, 7% stenosis, 2.1% aneurysm, 2.6% infection, 2.7% steal syndrome and 5.9% skin alterations). During the average period of dialysis (4.6 years), 38% of the patients needed more than one fistula. In that situation too, the same radiocephalic fistula was performed in the contralateral forearm (30%) prior to perform advanced procedures like PTFE-grafts (29%), etc. The patency rate after 3 years was 60.4% for radiocephalic fistula and 69.7% for PTFE transplants. The shuntthrombosis was again the main early (9.9%) and late (24%) postoperative complication. With help of a surgical thrombectomy or more conservative procedures like anticoagulation, local thrombectomy and transluminal angioplasty, 81.2%, respectively 64% of the failed fistula could be restored. Other complications like bleeding, aneurysms and infections occurred especially in arteriovenous grafts (0.5-5.7%).