Feasibility of creating autologous radiocephalic fistulas using thrombosed/stenotic cephalic veins

Abstract

Objective:

To explore the feasibility of establishing arteriovenous fistulas (AVFs) using thrombosed/stenotic cephalic veins in hemodialysis patients.

Methods:

For 27 patients with good vascular conditions but thrombosis and/or stenosis in the cephalic vein, the lesions were relieved by thrombectomy and/or percutaneous transluminal angioplasty (PTA), and radiocephalic AVFs were created. These patients composed the intervention group. A control group (n = 108) of patients with newly created AVFs was obtained via the propensity score matching method. The patients were followed up to observe the maturation and patency rates of AVFs.

Results:

In the intervention group, 25 patients (92.59%) achieved AVF maturation. The primary patency rates at 3, 6, 9, and 12 months were 95.8%, 87.5%, 83.3%, and 74.5%, respectively. The secondary patency rate remained at 95.8% after 6 months. In the control group, 85 patients (78.70%) achieved AVF maturation. The primary patency rates at 3, 6, 9, and 12 months were 98.8%, 91.3%, 76.1%, and 67.2%, respectively. The secondary patency rates at 12, 24, and 36 months were 92.3%, 89.4%, and 83.0%, respectively. No significant differences were observed in the AVF maturation rates or primary/secondary patency rates between the two groups (p > 0.05). Cox regression analysis also revealed that the decrease in primary or secondary patency did not significantly differ between the two groups (p = 0.60 and p = 0.21, respectively).

Conclusion:

Thrombosed/stenotic cephalic veins can be used for AVF creation as long as the lesions can be relieved during the perioperative period.