Primary and secondary patency rates and complications of upper extremity arteriovenous fistulae created for hemodialysis

The types of fistulae used and their complication rates are important for the hemodialysis patients. We aimed to compare retrospectively the primary and secondary patency rates and complications of upper extremity arteriovenous fistulae. Between 1984 and 2005, a total of 1,233 upper extremity arteriovenous fistulae were created in 920 patients. The mean age was 42 +/- 21 years. The fistulae were divided into the 3 groups; 588 radiocephalic, 205 brachiocephalic, and 127 were created by polytetrafluoroethylene graft. The fistulae types were evaluated with regard to their primary-secondary patency rates and complications. There was a significant difference with regard to development of thrombosis in radiocephalic group compared to other two groups, respectively, p = 0.0122, p = 0.0091. In brachiocephalic fistulae group, edema and steal phenomenon were statistically significant (p < 0.0001). The aneurysm formation was statistically significant in polytetrafluoroethylene fistulae graft group (p < 0.0001). During 6 months, 2 and 5 years period, while primary patency rate was higher in three fistulae types, in radiocephalic fistulae both primary and secondary fistulae patency rates were lower (p < 0.05). To create successful arteriovenous fistulae with long-term patency, appropriate veins of patients should be carefully preserved; thus initially a distal site should be preferred, and in case of failure the next fistulae should be created proximally. In case of failure of forearm fistulae, primary fistulae with autogenous veins should be tried at the upper arm first, and if this also fails, fistulae formation with synthetic grafts should be considered.