Twelve-year experience in the formation of arterio-venous fistulas in patients on chronic hemodialysis

The purpose of the study was to assess the structure and complications of permanent vascular access in patients on chronic hemodialysis, to calculate the five-year cumulative patency of arteriovenous fistulas (AVF) of various types and to determine the most preferred vascular access. Materials and methods 521 medical cases have been analyzed; 306 patients were at ESRD, 408 had permanent vascular access (PVA) formed between January 2000 and December 2011. Three groups were selected: group I of 307 patients with distal AVF; group II of 55 patients with proximal autovenous AVF (PAVF); group III of 46 patients with proximal AVF using synthetic vascular prostheses (AVG) was divided to subgroups IV and V. Results The structure of primary permanent vascular access (PVA): AVF - 87.8 %, PAVF - 6.8%, AVG- 5.4%. Secondary PVA: PAVF - 31.5%, AVG - 24.7%, AVF - 43.8%. Tertiary PVA: PAVF - 45.8 %, AVG - 45.8%, AVF - 8.3%. Patients of I group had 136 complications: 123 thrombosis (26 reconstructions, 22 thrombectomy), 3 aneurysms (resection), 6 stenosis (reconstruction), 4 insufficiency of blood flow, ligation of tributaries. Patients of group II had 26 complications: 23 thrombosis (10 thrombectomy), 2 aneurysms (resection), 1 case insufficiency of blood flow (ligation of tributaries). Patients of group III had 48 complications: 36 thromboses (26 thrombectomy, 1 reconstruction), 4 false aneurysm (resection), 6 cutaneous fistulas (excision), infection 2 (removal of the prosthesis). Cumulative fistula patency after 61 months: I gr. 37,79 %, II gr . 37,08%, III gr. 24,73%, IV gr. (brachial - subclavian AVG) 33,94%, V gr. (lower arm loop graft ) after 43 months - 0% . Conclusions: Among the primary vascular access the distal one dominated while for the secondary and tertiary access proximal arteriovenous fistulas dominated. The most frequent complication during the use of AVF fistula was thrombosis. The distal AVF and PPF have the best five-year cumulative patency.

хронический гемодиализ, артериовенозная фистула, осложнения, кумулятивная проходимость, chronic hemodialysis, arteriovenous fistula, complications, cumulative patency

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