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

Abstract

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.

• Authors: Sara Mokhtari, Aurélien Besancenot, Myriam Beaumont, François Leroux, Simon Rinckenbach, Lucie Salomon Du Mont
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 87 Pg. 495-501 (Nov 2022) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 35780948 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Topics

• Male
• Humans
• Aged
• Arteriovenous Shunt, Surgical (adverse effects)
• Vascular Patency
• Wrist
• Tobacco, Smokeless
• Risk Factors
• Treatment Outcome
• Retrospective Studies
• Renal Dialysis
• Upper Extremity (blood supply)
• Arteriovenous Fistula