Survival of arteriovenous fistulas and shunts for haemodialysis.

OBJECTIVE

To formulate a standard for assessing functional patency of vascular access and to present long-term results of vascular access in a group undergoing dialysis, in particular the effects of percutaneous transluminal angioplasty (PTA).

DESIGN

Retrospective study 1971-1980, prospective study 1980-1991.

SETTING

A unit for haemodialysis in a regional hospital, The Netherlands.

SUBJECTS

All 259 patients treated from 1971 to 1991 in a programme for chronic haemodialysis.

INTERVENTIONS

All interventions, surgical and radiological, needed to maintain vascular access.

MAIN OUTCOME MEASURES

Intervention free periods, patency of access, life expectancy of access, and early failure rate (within 4 days). Patency of access before and after PTA.

RESULTS

A total of 1179 interventions were made. 407 Arteriovenous (A-V) fistulas and shunts were constructed, and there were 519 surgical reoperations and 253 PTAs. The secondary cumulative patency rate for the autogenous distal A-V fistulas (Cimino) was 79% at one year, 68% at two years, and 59% at three years. Routine use of PTA from 1986 onwards resulted in a rise in secondary cumulative patency for Cimino A-V fistulas after two years from 65% to 80% (p > 0.05).

CONCLUSIONS

To describe and assess vascular access the patency rate alone is not sufficient; intervention free periods and life expectancy must also be given. Routine use of PTA with the Cimino A-V fistula resulted in an appreciable but not significant increase patency at two years.