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 i n a group undergoing dialysis, in particular the effects of percutaneo us transluminal angioplasty (PTA). Design: Retrospective study 1971-19 80, prospective study 1980-1991. Setting: A unit for haemodialysis in a regional hospital, The Netherlands. Subjects: All 259 patients treat ed from 1971 to 1991 in a programme for chronic haemodialysis. Interve ntions: All interventions, surgical and radiological, needed to mainta in vascular access. Main outcome measures: Intervention free period, p atency of access, life expectancy of access, and early failure rate (w ithin 4 days). Patency of access before and after PTA. Results: A tota l of 1179 interventions were made, 407 Arteriovenous (A-V) fistulas an d shunts were constructed, and there were 519 surgical reoperations an d 253 PTAs. The secondary cumulative patency rate for the autogenous d istal 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 t wo years from 65% to 80% (p > 0.05). Conclusions: To describe and asse ss vascular access the patency rate alone is not sufficient; intervent ion free periods and life expectancy must also be given. Routine use o f PTA with the Cimino A-V fistula resulted in an appreciable but not s ignificant increase patency at two years.