SURVIVAL OF ARTERIOVENOUS-FISTULAS AND SHUNTS FOR HEMODIALYSIS

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 period, 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.