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Background <p>The guidelines for patients with renal insufficiency recommend creating a&#xa0;radiocephalic arteriovenous fistula (RCAVF) in the distal forearm position. With failure rates ranging between 16% and 46%, early thrombosis often jeopardizes successful RCAVF maturation. Especially in countries like Germany, where the waiting time for kidney transplantation exceeds 9&#xa0;years, long-term patency of an AV access is of special importance; however, there is a&#xa0;lack of data for the recent years especially in Germany.</p> Objective <p>This study analyzed contemporary data from patients referred to the AV Access Reference Center in Munich, Germany evaluating the patency outcome of RCAVF created as initial vascular access.</p> Methods <p>We performed a&#xa0;retrospective cohort study for all newly created initial AV accesses from 2008–2022. The primary endpoint was efficacy assessed by successful first AV access use for a&#xa0;minimum of 30&#xa0;days and primary, primary assisted and secondary patency at 6, 12, 24 and 60&#xa0;months. A&#xa0;Kaplan-Meyer analysis was performed to estimate the probability of AV access failure.</p> Results <p>A&#xa0;total of 283 patients received an initial RCAVF (mean age&#xa0;64.3 years, SD 15.6&#xa0;years). Median follow-up was 34.7&#xa0;months. No follow-up information was available for 42&#xa0;patients, leaving 241 patients and of these 166 (68.9%) AV accesses continued to be used successfully until the end of the follow-up period. Primary failure with the need for a&#xa0;new access creation represented the leading cause of primary patency loss (<i>n</i> = 32, 11.3%). The primary patency at 12&#xa0;months was 60.4%, primary assisted patency was 79.0% and secondary patency was 84.7%. Primary patency was 43.4%, primary assisted patency was 67.0% and secondary patency was 78.9% after 60 months.</p> Conclusion <p>Despite the fact that the distal RCAVF can be jeopardized by early failure, it represents a&#xa0;durable AV access with excellent long-time patency rates. The positive outcome in our study might be due to the standard preoperative vessel assessment with ultrasound, performing the procedure using regional anesthesia and the experience of the vascular surgeon. Based on our results, a&#xa0;distal RCAVF has an outstanding value, especially in countries where patients face long waiting times for kidney transplantation.</p>

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A retrospective single-center study of forearm autogenous arteriovenous fistula creation and 60-month patency

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Edita Avanesov,
  • Solon Antoniades,
  • Tobias Traeger,
  • Alexander Hallwachs,
  • Nikolaos Tsilimparis,
  • Wolfgang Meichelböck,
  • Oliver R. Wolf

摘要

Background

The guidelines for patients with renal insufficiency recommend creating a radiocephalic arteriovenous fistula (RCAVF) in the distal forearm position. With failure rates ranging between 16% and 46%, early thrombosis often jeopardizes successful RCAVF maturation. Especially in countries like Germany, where the waiting time for kidney transplantation exceeds 9 years, long-term patency of an AV access is of special importance; however, there is a lack of data for the recent years especially in Germany.

Objective

This study analyzed contemporary data from patients referred to the AV Access Reference Center in Munich, Germany evaluating the patency outcome of RCAVF created as initial vascular access.

Methods

We performed a retrospective cohort study for all newly created initial AV accesses from 2008–2022. The primary endpoint was efficacy assessed by successful first AV access use for a minimum of 30 days and primary, primary assisted and secondary patency at 6, 12, 24 and 60 months. A Kaplan-Meyer analysis was performed to estimate the probability of AV access failure.

Results

A total of 283 patients received an initial RCAVF (mean age 64.3 years, SD 15.6 years). Median follow-up was 34.7 months. No follow-up information was available for 42 patients, leaving 241 patients and of these 166 (68.9%) AV accesses continued to be used successfully until the end of the follow-up period. Primary failure with the need for a new access creation represented the leading cause of primary patency loss (n = 32, 11.3%). The primary patency at 12 months was 60.4%, primary assisted patency was 79.0% and secondary patency was 84.7%. Primary patency was 43.4%, primary assisted patency was 67.0% and secondary patency was 78.9% after 60 months.

Conclusion

Despite the fact that the distal RCAVF can be jeopardized by early failure, it represents a durable AV access with excellent long-time patency rates. The positive outcome in our study might be due to the standard preoperative vessel assessment with ultrasound, performing the procedure using regional anesthesia and the experience of the vascular surgeon. Based on our results, a distal RCAVF has an outstanding value, especially in countries where patients face long waiting times for kidney transplantation.