Remarks on surgical strategy in creating vascular access for hemodialysis:: 18 years of one center's experience

The aim of the study is to evaluate surgical methods for creating vascular access for hemodialysis (HD) in patients with chronic renal failure. Over the last 18 years, 1,827 surgical procedures were performed in 722 patients (399 men and 323 women, mean age 43.7 +/- 17 years) in order to provide and maintain permanent vascular access for HD. Among all the surgical procedures, 992 were based on the construction of arteriovenous fistulas (AVF) and 835 were undertaken as secondary reparative surgical procedures. A total of 992 vascular accesses have been performed, including 904 AVF on upper and 14 on lower extremities as well as insertion of 74 permanent catheters. Radiocephalic AVF (RCAVF) was the principal type of AVF (58.8%). While constructing secondary angio-access after using RCAVF on the other extremity, fistulas with usage of brachial vessels were preferred. A total of 228 AVF of this type were created, including 143 brachiocephalic (BCAVF) and 85 brachiobasilic (BBAVF) AVF. Lately, synthetic grafts (arteriovenous graft, AVG) have been used more frequently, in 90 AVF. A brachial straight graft was the main type procedure performed, with polytetrafluoroethylene (95.6%). The patency of the fistulas has been evaluated. Kaplan-Meier survival curves were calculated to determine primary, primary-assisted, and secondary patency. Log-rank analysis was used to determine differences between curves. Primary, primary-assisted, and secondary patency at 12 months and 24 months were calculated. Comparing AVF patency in two patients' age periods (18-65 years, > 65 years), it may be concluded that in the elderly group AVG provides better treatment for AVF. Finally, we conclude that a multidisciplinary approach to vascular access strategy offers the best option to achieve good functional AVF. Autogenous arteriovenous access should be regarded as the most suitable type in creating VA. However, individual conditions should be taken into consideration.