The reasons for the failure of the primary arteriovenous fistula surgery in patients with end-stage renal disease

• Yang Jiu Zhao
• Professor of Nephrology, Department of Nephrology, Dalian Medical University Second Affiliated Hospital
• No.176 Zhong Shan Road, Dalian, 116023, P. R. China
• zhaojiuy@medmail.com.cn

To analyze the reasons for the failure of the primary arteriovenous fistula surgery and explore preventive measures.

A total of 819 patients with end-stage renal disease were enrolled in the study. Autologous arteriovenous fistula surgery was performed on all patients. Their clinical data of hemoglobin (HB), albumin (ALB), cholesterol (CHOL), parathyroid hormone (PTH), blood glucose and blood pressure were collected before surgery, while the diameters of the radial artery and cephalic vein were measured by ultrasound.

The operations in 742 patients were successful, but failed in 77 cases (accounting for 7.07%). The failure group was significantly older (61.3 ± 13.4 years) than the successful group (45.6 ± 11.2 years). The ratio of diabetes 36 (46.8%) and hypertension 20 (26.0%) was significantly higher in the failure group than in the successful group, respectively 235 (31.7%) and 145 (19.5%). The patients with blood pressure below 120/70 mm Hg had a higher risk of failed surgery (36.4%) than those with blood pressure above 120/70 mm Hg (9.16%). The cephalic vein and radial artery diameter were significantly smaller in the failure group (1.35 ± 0.64 cm, 2.13 ± 0.81 cm) than in the successful group (1.98 ± 0.47 cm, 2.47 ± 0.74 cm); the PTH levels in the failure group were significantly higher (782.39 ± 423.85) than in the successful group (378.83 ± 352.21).

The autogenous arteriovenous fistula surgery failure highly correlated with the patient’s age, blood pressure, the primary disease and the vessel diameter. In addition, the PTH levels had a certain correlation with the failure of the fistula surgery.