A New Standard of Care for Dialysis Access? Achieving High Usability and Long Term Patency Creating Rates Arteriovenous Fistula with External Support: A Large Retrospective Review

176 procedures, 162 were autogenous arteriovenous fistula formation, while 14 were non-autogenous arteriovenous graft procedures.The mean age of those having autogenous fistula was 64.5 Æ 13.9 years and 65.4% were men.While patients undergoing arteriovenous graft had a mean age of 55.4 Æ 15.6 years and 35.7% were men.Patients undergoing arteriovenous graft surgeries were significantly younger (p < .05)with a female predominance (p < .05),compared to those having autogenous fistulas.Ninety-two (52.3%) procedures were performed in the predialysis population; their mean estimated glomerular filtration rate (eGFR) at the time of operation was 11.15 mL/minute/1.73m 2 .In the predialysis group, 24 (13.6%) had a functioning access at 12 months but did not require dialysis.The overall six month primary, primary assisted, and secondary patency rates were 73.3%, 79.4%.and 82.4%, respectively, whereas the 12 month primary, primary assisted, and secondary patency rates were 63.7%, 70.3%, and 73.4%, respectively.These data were censored for deaths, transplants, those lost to follow up, and transfers.The primary failure rate was 13.6% (n ¼ 24) among all procedures.There were 33 (18.7%) radiological interventions with or without thrombectomy and 41 (23.3%) were secondary surgical interventions.Twelve (16.8%) patients underwent renal transplantation during the follow up period, while 18 (10.2%)were deceased.The one year patency rates for brachiocephalic fistula was 74.4% versus 73% for radiocephalic fistula, while two staged basilic vein transpositions had a one year secondary patency rate of 90%.Autogenous fistulas provided significantly superior results compared with non-autogenous graft surgeries in terms of secondary patency rate, 73.8% versus 69.2% (p < .05).Autogenous fistulas also had significantly fewer interventions compared with those for arteriovenous grafts (35.9% vs. 46.1%;p < .05).Nineteen per cent (n ¼ 33) of the study population were still dialysing through a central venous line catheter by the end of the follow up period.Conclusion: Autogenous arteriovenous fistulas had better patencyand had fewer interventions than arteriovenous grafts.Patients who had graft formations were younger, with a female predominance.Basilic vein transpositions had the best secondary patency rates at one year.Wrist and elbow fistula patency was comparable, possibly owing to appropriate case selection.Timing of access creation in predialysis patients is crucial.We feel that our cohort were listed appropriately.