FAILURE OF DIALYSIS ACCESS - REVISE OR REPLACE

Providing adequate long-term dialysis access has become increasingly d ifficult. In order to evaluate the operative factors associated with e arly failure of dialysis access, 2337 operations performed in 1124 pat ients over an 8-year period were retrospectively reviewed, Evaluation of 1306 procedures that eventually failed and required operative revis ion or repair provided the basis for this study. Access failure occurr ed in 459 (41%) of the 1124 patients, An average of 2.8 episodes of fa ilure (range 1-13) were observed among this group of patients, occurri ng after an average of 230 +/- 9 days (mean +/- standard error) postop eratively, with the longest interval to failure being 2529 days. The t ime-to-failure for revision of a preexistent arteriovenous fistula or prosthetic graft (140 +/- 9 days, n = 449) was significantly (P < 0.00 01 ANOVA) shorter than for creation of an arteriovenous fistula (272 /- 21 days, n = 336) or prosthetic graft (299 +/- 19 days, n = 372) at a new site. Procedures performed in octogenarians tended to fail earl ier (178 days), Dialysis access failure tends to recur in patients wit h a history of previous access problems. The time-to-failure was simil ar for new prosthetic grafts and arteriovenous fistulas, but twice as long compared to revision of a previous access site. (C) 1996 Academic Press, Inc.