Operative salvage of radiocephalic arteriovenous fistulas by formation of a proximal neoanastomosis

Objective: We examined the outcomes of radiocephalic arteriovenous fistulas salvaged by formation of a neoanastomosis in the proximal cephalic vein segment. Methods: Patients with a radiocephalic arteriovenous fistula revised by formation of a neoanastomosis in the proximal cephalic vein segment were identified from a prospectively maintained database and outcomes retrospectively analyzed. Results: Eighty patients had 81 radiocephalic arteriovenous fistulas revised by formation of a neoanastomosis in the proximal cephalic vein segment. Failure to mature was the indication for revision in 39 (48.1%), 17(21.0%) were revised for poor flows during dialysis, and 25 (30.9%) were performed for thrombosis. Primary patency of the 81 neoanastomoses at 12, 24, and 36 months was 78.5%, 68.9%, and 54.9%, respectively. Compared with neoanastomoses that were performed on 50 immature radiocephalic arteriovenous fistulas, those performed on the 31 mature fistulas exhibited improved patency rates (P = .04). There was no difference in the primary patency of the neoanastomosis between those performed for 25 failed fistulas and 56 failing (but patent) fistulas (P = .15). There was one case (1.2%) each of bleeding, infection, and steal after neoanastomosis. Four patients (4.9%) required further interventions on their neoanastomoses. Conclusions: Operative salvage of radiocephalic arteriovenous fistulas by formation of a neoanastomosis in the proximal cephalic vein segment demonstrates good patency and low complication rates and can be performed with reasonably good results in patients with failed or failing (but patent) radiocephalic arteriovenous fistulas. These patients should not automatically proceed to elbow fistula formation; rather, proximal neoanastomosis should be considered. (J Vasc Surg 2011;54:168-73.)