Postoperative complications following hemodialysis access procedures

Abstract

From July 1986 to September 1996, 322 arteriovenous fistulas were constructed in 250 patient for permanent hemodialysis: 315 autogenous and 7 graft fistulas (polytetraflouroethylen (PTFE)-4, dacron-3). 269 snuff box (84%), 29 radiocephalic (8%), 24 brachiocephalic (7%) and 1 subclavian (0.3%) arteriovenous fistulas were performed. Successfull rate at first operations (255/322) was 79%. In the immediate postoperative period, 54 snuff box fistulas (20%) developed complications (52 early occlusion and 2 postoperative local bleeding) while 6 radiocephalic fistulas (20.6%) developed immediate postoperative complications (5 early occlusion and 1 anastomotic hemorrhage). Brachiocephalic fistulas didn't developed any immediate postoperative complications. In the long-term period 9 brachiocephalic fistulas (37.5%) developed complications (4 venous return dysfunction 3 aneurysm 1 graft infection and 1 late trombosis) while 4 snuff box fistulas and 1 radiocephalic fistulas developed late trombosis. Based on this complication rates, we should make every effort to construct the autogenous snuff box fistula as the first choice of hemodialysis access procedure in properly selected patients.