Native Arteriovenous Fistula for Hemodialysis Access : Problems of Primary Failure
Keywords:arteriovenous fistula, hemodialysis vascular access
AbstractIntroduction: Native arteriovenous fistula is recommended as vascular access of choice for long term
hemodialysis. However , the major problem of native arteriovenous fistula (AVF) is its primary failure.
Objective: To study the incidence of primary failure of native arteriovenous fistula and determine the
factors associated with its primary failure.
Materials and Methods: All consecutive hemodialysis patients or patients with chronic kidney disease
requiring a permanent vascular access from September 2003 to June 2011 were included in the study. All patients
underwent native arteriovenous fistula as the first procedure. The relation between clinical characteristics with
risk of primary failure was studied using logistic regression analysis.
Results: The primary failure rate was 36.3% (66 of 182 patients). The factors related to an increased risk
of primary failure were female gender (odds ratio(OR) : 1.468,95%, confidence interval (CI) : 0.799-2.698), age
equal or more than 65 years (OR : 1.53, CI : 0.807-2.902), diabetes mellitus (OR : 1.437, CI : 0.756-2.733), AVF
placement at wrist (compared with at elbow) (OR : 1.542, CI : 0.525-4.538), and AVF placement after
hemodialysis (compared with placement before hemodialysis) (OR : 4.375, CI : 1.248-15.338). Timing of AVF
placement (before or after hemodialysis) was statistically significant related to the primary failure rate (p-value
Conclusion: Primary failure is a major problem for native arteriovenous fistula. Our study showed that
AVF placement after establishment of hemodialysis was significant factor associated with the primary failure. The
brachiocephalic AVF had lower primary failure rate than radiocephalic AVF and could be a good alternative choice in
case of previous unmature radiocephalic AVF.
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