PRIMARY ACCESS SURGERY FOR LONG-TERM HEMODIALYSIS

This paper assessed the efficacy of arterio-venous fistulae, vein graf ts, and synthetic grafts for long-term haemodialysis. Over a selected 10 year period, 486 primary access sites were established and 182 revi sions were necessary. Access procedures were assessed for primary surv ival, the success or otherwise of revision surgery, and long-term effi cacy for haemodialysis. Significant differences were shown for long-te rm survival of fistulae over vein grafts and synthetic grafts. Success ful revision surgery favoured fistulae over synthetic grafts. Arterio- venous fistulae offered the best prospect for effective long-term dial ysis. Revision surgery with continued dialysis using the primary-acces s site was largely unsuccessful, secondary access reconstruction being required in 78.2% of all failures.