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Snuff-Box Versus Wrist Radiocephalic Arteriovenous Fistulas for Hemodialysis: Maturation Tend and its Affecting Factors

  • Sara Mokhtari
    Correspondence
    Correspondence to: Dr. Sara Mokhtari, Vascular Surgery Department, Mohammed VI University Hospital, Oujda, Morocco
    Affiliations
    Vascular Surgery Department, Mohammed VI University Hospital Center, Oujda, Morocco

    Vascular and Thoracic Surgery Department, Nord Franche-Comté (NFC) Hospital, Trévenans, France

    University Mohammed 1st. Faculty of Medicine and Pharmacy of Oujda, Oujda, Morocco

    University of Franche-Comté (UFR), Besançon, France
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  • Aurélien Besancenot
    Affiliations
    Vascular and Thoracic Surgery Department, Nord Franche-Comté (NFC) Hospital, Trévenans, France

    University of Franche-Comté (UFR), Besançon, France

    Vascular Surgery Department, Besançon University Hospital, Besançon, France
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  • Myriam Beaumont
    Affiliations
    Vascular Medicine Department, NFC Hospital, Trévenans, France
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  • François Leroux
    Affiliations
    Vascular and Thoracic Surgery Department, Nord Franche-Comté (NFC) Hospital, Trévenans, France
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  • Simon Rinckenbach
    Affiliations
    Vascular Surgery Department, Besançon University Hospital, Besançon, France

    EA3920, UFR Santé, Université de Bourgogne-Franche-Comte, Besançon, France
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  • Lucie Salomon Du Mont
    Affiliations
    Vascular Surgery Department, Besançon University Hospital, Besançon, France

    EA3920, UFR Santé, Université de Bourgogne-Franche-Comte, Besançon, France
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      Background

      Thanks to its well proved long-term patency rates, native radiocephalic arteriovenous fistula remains the most commonly used vascular access type. Many articles had approached the criteria leading to a mature fistula. The aims of this work are to evaluate variables that may affect the maturation of distal fistulas and to determine if wrist fistulas have less risk of maturation failure than the snuff-box fistulas.

      Methods

      We recorded all distal radiocephalic fistulas that had been created from January 2018 to February 2021. Epidemiological and clinical profile of patients, characteristics of performed fistulas and per and post-operative data were recorded and analyzed.

      Results

      From January 2018 to February 2021, 165 upper limb vascular accesses for hemodialysis had been created including 47 (28.5%) distal radiocephalic fistulas. Among the latter, 39 (83%) fistulas were performed at the wrist and 8 (17%) at snuff-box area. There were 34 men (72.3%). Mean age was 67 years (37–87). Both types of fistulas had approximately an identic frequency of primary maturation failure (50% for radiocephalic versus 47.2% for snuff-box fistulas). Secondary maturation had been achieved in 9 fistulas. Patients with medical history of dyslipidemia, peripheral arterial disease (PAD), central catheter placement, and bad quality of vessels tend to develop an immature fistula.

      Conclusions

      No significant differences in maturation tend between snuff-box and wrist fistulas had been demonstrated. Thus, it seems reasonable to privilege the creation of the most distal fistulas allowing preservation of wrist fistulas as a second option in case of snuff-box fistulas maturation failure. However, selection of the most suitable cases for snuff-box fistulas creation, based on clinical and duplex ultrasound data, remains primordial.
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