Autogenous Vascular Access In American Indians
Ryan Christie, Kelly Kempe, MD, Viraj Pandit, MD, Peter Nelson, MD, MS, William C. Jennings, MD.
University of Oklahoma College of Medicine - OU-TU School of Community Medicine, Tulsa, OK, USA.
OBJECTIVES: American Indians (AI) have the highest prevalence of diagnosed diabetes which continues to be the leading primary cause of end stage renal disease (ESRD). As a consequence, ESRD in AI is 1.5 times greater than White Americans, but there are limited studies in this population regarding hemodialysis outcomes. We review our experience creating autogenous vascular access for AI patients.
METHODS: Consecutive new referrals who self-identified as AI and underwent creation of a vascular access for hemodialysis during a ten-year period were reviewed retrospectively. Patient demographic data, access outcomes, operative procedures and complications were analyzed. Vascular mapping was performed by the operating surgeon to create the operative plan.
RESULTS: All patients had an autogenous access constructed. 235 AI were treated during the study period and all were included in the analysis. 196 (83%) of the patients were diabetic, 99 (42%) were men, and 64 (27%) obese. Mean age was 57 years (15-89 years). 86 (37%) had a previous failed access operation. The procedures included 158 (67%) direct AVFs and 77 (33%) transpositions or translocation procedures. Mean follow-up was 22 months (1-110 months). 173 (74%) of the access operations used the radial or ulnar artery for AVF inflow. Three patients developed steal syndrome, all treated successfully with access preservation. Six patients had ipsilateral AVFs created after a failed graft placed elsewhere. Primary and cumulative patency rates were 59.6% and 93.4% at 12 months and 59.4% and 92.4% at 24 months, respectively.
CONCLUSION: Despite higher rates of obesity, diabetes, and previous failed access attempts, a safe and functional autogenous vascular access was created in 235 American Indian patients with cumulative patency of 92.4% at 24 months. Because AI have such a high rate of ESRD and there are very few studies in this patient population, we urge continued reporting.
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