Improvements in dialysis access survival with increasing use of arteriovenous fistulas in a Veterans Administration medical center.

Background: Native arteriovenous fistulas (AVFs) have been found to exhibit higher survival rates and lower complication rates than prosthetic grafts (AVGs).

Methods: Between August 2001 and December 2003, 93 patients with end stage renal disease (ESRD) had primary dialysis access placed at a single Veterans Administration medical center. Of these 93 patients, 67 had AVFs created and 26 patients had AVGs implanted.

Results: The percentage of patients who did not require additional intervention was 84% (56 of 67) for AVF and 78% (21 of 26) for AVG after 4 to 31 months of follow-up evaluation. In the AVF group, repeat interventions were as follows: collateral ligation (4), angioplasty owing to central stenosis (2), AVF ligation due to arterial steal phenomenon (1), and new AVF creation owing to clotting (1). Four AVFs were later converted to AVG. In the AVG group there were 4 venous anastomosis stenosis seen in 3 patients who required angioplasty. Two patients needed thrombectomy and revision, and 1 graft was removed because of infection. AVF prevalence in our dialysis patients was 63%, with 33% AVG and 4% temporary catheter.

Conclusions: The National Kidney Foundation-Dialysis Outcome Quality Initiative (NKF-DOQI) guidelines for dialysis access reawakened interest in maximizing the use of renal veins for AVF. AVFs created by using the patient's native vein provides the best vascular access for dialysis when compared with prosthetic grafts. AVF has better long-term patency with fewer complications.