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KMID : 0371320030640030243
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Journal of the Korean Surgical Society
2003 Volume.64 No. 3 p.243 ~ p.250
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The Effect of Reoperation on the Patency Rate of Arteriovenous Fistula for Hemodialysis
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Chu Young-Keun
Kim Myoung-Soo
Han Byoung-Geun
Choi Seung-Ok
Cho Nam-Cheon
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Abstract
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PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of an arteriovenous fistula (AVF) for hemodialysis.
METHODS: Between March 1997 and December 2001, a total of 397 AVF operations in 314 patients were performed by a single surgeon using the same surgical technique and principles. One hundred and forty cases (35.3%) were reoperations due to previous AVF failure. Artificial vessels (=PTFE, polytetrafluoroethylene) were used for the AVF in 39 cases (9.8%). The sex, age, diabetes mellitus, previous operation history and type of dialysis center were considered as a possible risk factors affecting the patency rate.
RESULTS: After a mean follow-up of 18.3 months, there were 63 cases of patient death, 15 of kidney transplantation, and 104 of AVF failure identified. The overall patency rates of 1, 2 and 3 year were 76.2, 70.9, and 66.9%, respectively. From the multivariate analysis, the previous operation history was the only significant factor affecting the patency rate of AVF (P=0.001, odd ratio=2.58). Although the diabetic patient (odd ratio=1.43) and artificial vessel groups (odd ratio=1.678) showed high odd ratios, these factors were not statistically significant (P > 0.05). From the univariate analysis, the reoperation cases also showed a significantly inferior patency rate compared to the first operation cases (1 year patency rate was 65.2% and 83.7%, P=0.001). However, the diabetes and types of vessel showed no significant differences in patency rates.
CONCLUSION: A reoperation of an AVF creation was the most significant risk factor affecting the patency rate after its original creation. The first attempt AVF creations showed-favorable patency rates. To improve the overall patency rate of an AVF creation, a more delicate preoperative study and accurate surgical technique will be required at the time of the first AVF operation.
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KEYWORD
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Arteriovenous fistula (AVF), Patency rate, Reoperation
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