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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Article Info
Publication History
Published online: June 29, 2022
Accepted:
May 18,
2022
Received:
March 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Competing interests: All authors have no conflict of interests.
Funding: There was no financial support received for this work.
Author contributions: Study conception and writing: SM. Data Collection: SM, MB, LSDM. Analysis: SM, AB, LSDM, FL. Investigation: SM, LSDM, SR. Critical review and revision: all authors. Final approval of the article: all authors. Accountability for all aspects of work: all authors.
Ethical statement: Not applicable. This study does not require a statement from ethical committee.
Identification
Copyright
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