Outcomes of Secondary Compared to Primary Autogenous Haemodialysis Arteriovenous Fistulae, a Five Year Survey

Aims: We examined the outcome and patency rates of secondary in comparison to primary arteriovenous fistulae (AVF) in a cohort of haemodialysis (HD) patients.
Study design: A retrospective review of native AVFs formed in a five year period.
Place and Duration of Study: Department of Renal and Vascular Medicine Hull and East Yorkshire Hospitals NHS Trust, East Yorkshire between December 2000 to December 2005.
Methodology: HD patients who had autogenous AVF created in a single centre over a 5 year period. 346 patients (mean age 61±16 years, 35.8% females, 29.2% diabetics) were included. Data on type of AVF, demographics, co-morbidities, immediate outcome and subsequent vascular access (VA) patency were collected.
Results: 463 AVF were created (304 radiocephalic (RC) and 159 brachiocephalic (BC)), of which 160 (34.6%) were secondary procedures. There was no significant difference in the primary failure rate (PFR) of primary and secondary AVFs (38.9 vs. 37.5% respectively). Primary RC fistulae had a higher failure rate in comparison to BC fistulae (42.6 and 21.3%, respectively, p = 0.002, OR 2.7; CI: 1.4-5.3). There was a higher PFR of AVF among females (primary access: 47 vs. 33% in males, p = 0.028; OR 1.7; 95% CI: 1.1-2.8; secondary access: 53 vs. 27%, p= 0.002; OR 3.1; 95% CI: 1.5-6). There was no difference in PFR of primary and secondary fistulae among diabetics and non-diabetics.
Conclusion: The primary success rate of secondary autogenous AVFs is similar to primary fistulae. Females have a higher rate of fistula failure.