Mekhola Mallik, MBBS, MRCS, Rajesh Sivaprakasam, MBChB, MRCS, Gavin J

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Presentation transcript:

Operative salvage of radiocephalic arteriovenous fistulas by formation of a proximal neoanastomosis Mekhola Mallik, MBBS, MRCS, Rajesh Sivaprakasam, MBChB, MRCS, Gavin J. Pettigrew, MD, FRCS, Chris J. Callaghan, PhD, FRCS Journal of Vascular Surgery Volume 54, Issue 1, Pages 168-173 (July 2011) DOI: 10.1016/j.jvs.2010.12.050 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Patency rates of radiocephalic arteriovenous fistulas (RCAVFs). Whereas primary patency rates of the RCAVF were poor (37.0%, 17.3%, and 6.2% at 12, 24 and 36 months, respectively; solid line), primary patency rates of the neoanastomoses (NEO) were acceptable (78.5%, 68.9%, and 54.9% at 12, 24, and 36 months, respectively; open squares). Consequently, the overall (secondary) patency for the RCAVFs was substantially improved by NEO formation (87.3%, 81.2%, and 72.0% at 12, 24, and 36 months, respectively; crosses [n = 81]; P < .01). Where the standard error (SE) exceeds 10%, the survival curve has been depicted with a dotted line. N, Number of fistulas at risk.Patency ± SE, % (N)12 months24 months36 monthsPrimary patency of RCAVF37.0±5.4(30)17.3±4.2(14)6.2±2.7(5)Primary patency of NEO78.5±5.0(40)68.9±6.4(20)54.9±9.0(5)Secondary patency (RCAVF + NEO)87.3±3.7(63)81.2±4.6(43)72.0±6.0(24) Journal of Vascular Surgery 2011 54, 168-173DOI: (10.1016/j.jvs.2010.12.050) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Primary patency of the neoanastomoses (NEO) stratified by maturity and by patency status. A, Primary patency of the NEO performed on mature fistulas at 12, 24, and 36 months was 88.3%, 78.6%, and 78.6%, respectively (circles, n = 31), whereas primary patency of the NEO of immature fistulas was significantly poorer at 72.4%, 62.5%, and 41.0% at 12, 24, and 36 months, respectively (squares, n = 50; P = .04). Where the standard error (SE) exceeds 10%, the survival curve has been depicted with a dotted line. N, number of fistulas at risk.FistulaPatency ± SE, % (N)12 months24 months36 monthsMature88.3±6.4(20)78.6±8.6(10)78.6±8.6(3)Immature72.4±7.0(20)62.5±8.9(10)41.0±11.8(3) Journal of Vascular Surgery 2011 54, 168-173DOI: (10.1016/j.jvs.2010.12.050) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2. B Primary patency of the NEO for failed fistulas at 12, 24, and 36 months was 68.8%, 56.0%, and 46.7%, respectively (rectangles, n = 25) and was comparable to failing (but patent) fistulas, which was 83.3%, 74.9%, and 59.0% at 12, 24, and 36 months, respectively (ovals, n = 56; P = .15). Where the standard error (SE) exceeds 10%, the survival curve has been depicted with a dotted line. N, Number of fistulas at risk.FistulaPatency ± SE, % (N)12 months24 months36 monthsFailed68.8±10.0(12)56.0±11.6(6)46.7±12.9(2)Failing83.3±5.4(28)74.9±7.5(14)59.0±11.7(4) Journal of Vascular Surgery 2011 54, 168-173DOI: (10.1016/j.jvs.2010.12.050) Copyright © 2011 Society for Vascular Surgery Terms and Conditions