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Arguments in favour of a homologous concept for hemodialysis access procedures. Feasibility and results.

OBJECTIVES
Autologous arterio-venous (AV) fistulas seem to be superior to prothetic grafts in hemodialysis access surgery. We used an algorithm which enabled us to use autologous vein in over 99% of all fistula operations.


DESIGN
All patients undergoing hemodialysis surgery during a three year period (n = 102) were enrolled in an open prospective observation study with the end points feasibility, perioperative complications and patency.


MATERIALS
One hundred and two patients were followed until the end of the observation period (30/6/01).


METHODS
All relevant data were recorded prospectively. The status of the individual fistula was recorded twice a year until the end of the observation period. Fistula-patency was calculated by life-table-analysis according to Kaplan-Meier.


RESULTS
Except one patient presenting with a recurrent shunt aneurysm, no patient received prothetic material. At the end of the observation period all patients alive and under dialysis could use their autologous fistula. There was no perioperative mortality. One reoperation was required for a septic anastomotic rupture. Otherwise, only minor complications were observed. Cumulative 1-year and 3-year patency were 78.5 and 62.8% respectively for the Cimino and 75.2 and 66.8% for elbow fistulas.


CONCLUSIONS
An autologous approach is nearly always possible. Besides fewer complications, the approach seems to be cost effective.