Gerald A. Beathard, MD, PhD; Allen R. Nissenson, MD;  Salim Mujais, MD and Physician Operators RMS Lifeline

DOQI has recommended autogenous arteriovenous fistulae as the preferred hemodialysis vascular access. Although generally such fistulae function for a greater period of time than synthetic graft accesses, there is increasing need for salvage of such fistulae. We have reviewed prospectively collected data on all patients with autogenous fistulae referred to six dedicated hemodialysis access interventional centers.

901 access procedures in 745 patients with autogenous fistulae, referred from January 1, 2001- March 31, 2002, are included. Demographic and co-morbid conditions for our patients were similar to the general dialysis population other than a preponderance of males (67.9% male, 32.1% female). The results were analyzed for success of the procedure and complications. Indications for endovascular treatment included thrombosis, poor flow/dialysis clearing, elevated pressure, and failure to mature. 

816 of the 901 procedures were for the diagnosis or treatment of autogenous fistula dysfunction.

The major reasons for referral to the access centers included flow restriction (16%), thrombosis (16%), increased venous pressure (13 %), immature access (11 %), decreased Kt/V or URR (11%) and inability to cannulate (7%). The procedures performed included declotting (13%), access angiograms with subsequent PTA (53%), and diagnostic angiographic exams without endovascular therapy (24%). 3% of the patients required the ligation of a collateral vessel and a clinical exam only was performed on 3% of the fistulae. Success rates were 96%. Complications were 4%. A hematoma/extravasation not affecting flow accounted for 96% of the complications reported. Immature fistulae were converted to useful and full maturity in 69% of cases presenting as failure to mature.

Interventional procedures done in a dedicated setting have a high success rate performed in a time efficient and cost effective manner with minimal morbidity. Such procedures include converting immature fistulae to functional accesses, and should increase the goals for prevalent autogenous fistulae set in the KDOQI clinical practice guidelines.


Disclosure:
All authors are either employees or consultants of Baxter Healthcare. RMS Lifeline is an affiliate of Baxter Healthcare.