Secondary vascular access procedures for hemodialysis after primary snuff-box arteriovenous fistula

Abstract

AimTo investigate the secondary arteriovenous fistulas constructed after a snuff-box fistula.MethodWe reviewed data on 95 arterio-venous fistulas that were created as a secondary vascular access between January 2007 and December 2015. Of those 95 fistulas, 37 (39%) were ip-silateral elbow brachial-cephalic arteriovenous fistulas and 58 (61%) were ipsilateral wrist radial-cephalic arteriovenous fistulas; all were created after a primary snuff-box fistula.ResultsAll arteriovenous fistulas had matured. The primary patency rates for elbow brachial-cephalic arteriovenous fistulas and radial-cephalic arteriovenous fistulas were as follows: 1-year rate, 88% to 87% and 4-year rate, 70% to 61%. The secondary patency rates for were as follows: 1-year rate, 91% to 93%; 4-year rate, 72% to 63%. No early failure occurred. There were 15 late failures. The most common causes of failure were stenosis within the vein (n=8 patients), aneurysm (n=5 patients), and central vein stenosis (n=2 patients).ConclusionThese data suggest that before a radial-cephalic or brachial-cephalic arteriovenous fistula is cre-ated, the construction of a snuff-box fistula enable the vascular structures to dilate, and may so fascilitate the success rate of seconder AVFs. For this reason a radial-cephalic arteriovenous fistula or an elbow brachial-cephalic arteriovenous fistula should be the second choice.

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