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Patients on haemodialysis are better served by a proximal arterio-venous fistula for long-term venous access
Sherif Sultan, MD FRCS FACS, Niamh Hynes, MB BCh MRCS MMSc MD.
Western Vascular Institute, Galway, Ireland.
End Stage Renal Disease (ESRD) patients should have Arterio-Venous Fistula (AVF) formation 3-6months prior to commencing Haemodialysis (HD). However this is not always possible with strained healthcare resources.
We aim to compare autologous Proximal AVF (PAVF) with Distal AVF (DAVF) in patients already on HD. Primary endpoint is 4-year functional primary. Secondary endpoint is freedom from major adverse clinical events (MACE)
From January 2003 to June 2009, out of 495 AVF formations, 179 (36%) patients were already on HD. These patients had 200 AVF formations (49 DAVF vs. 151 PAVF), in arms in which no previous fistula had been formed. No synthetic graft was used.
4-year primary functional patency significantly improved with PAVF (68.9%+/-SD8.8%) compared to DAVF (7.3%+/-SD4.9%) (p<0.0001)
5-year freedom from MACE was 85% with PAVF compared to 40% with DAVF (P<.005)
PAVF bestows long-term functional access with fewer complications compared to DAVF for patients already on HD.
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