Patient-related factors influencing patency of autogenous brachiocephalic haemodialysis fistulas. Issue 1 (March 2017)

• Record Type: Journal Article
• Authors: Lamprou, Alexander; de Bruin, Cor; van Roon, Arie; Loonstra, Jan; van der Laan, Maarten; Tielliu, Ignace; Zeebregts, Clark
• Is Part Of: Journal of vascular access. Volume 18:Issue 1(2017)Supplement
• Page Start: S104
• Page End: S109
• Publication Date: 2017-03
• Subjects: Brachiocephalic fistula -- Diabetes -- Gracz -- Haemodialysis -- Patency -- Predictor -- Failure; Arterial catheterization -- Periodicals; Intravenous catheterization -- Periodicals; 612.13
• DOI: 10.5301/jva.5000675
• Languages: English
• ISSNs: 1129-7298

Abstract

Objective: The objective of this study was to analyse the outcome of autogenous brachiocephalic fistula for dialysis purposes and to determine modifiable and non-modifiable patient-related factors of influence on the patency of a newly created fistula. Design of study: A single-centre retrospective cohort study with the aim of determining patient-related factors of influence on primary failure, primary, primary assisted and secondary patency of autogenous brachiocephalic fistulas. Seventeen patient-related variables were determined by means of univariate analysis, variables reaching significance were then entered in a multivariate Cox-regression model. Results: Between October 2005-October 2015, 231 autogenous brachiocephalic fistulas were created in 228 patients. Mean age was 61.3 years (20.3-88.2 years). Patency was calculated using Kaplan-Meier analysis. Primary failure occurred in 38 out of 231 created fistulas (16.5%). The primary, primary assisted and secondary patency rates at six months were 78 ± 3%, 93 ± 2%, and 95 ± 1%, respectively. At 12 months, they were 63 ± 3%, 89 ± 2%, and 92 ± 2%, and at 24 months 47 ± 4%, 84 ± 3%, and 89 ± 2%. The non-modifiable factors, diabetes mellitus and mean cephalic vein diameter were identified as a predictor for failure influencing primary and secondary patency. The preoperative use of anticoagulation was identified as a modifiable factor for failure. Conclusions: This study identified several non-modifiable and modifiable factors of interest to the clinician deciding on which type of haemodialysis fistula is most suitable for an individual patient. Meticulous preoperative work-up, a surveillance programme, and a dedicated multidisciplinary team can be of great importance in achieving better patency rates.