[Role of autologous antebrachial arteriovenous fistula for vascular access in hemodialysis].

Numbers of arteriovenous (AV) fistula creation increase worldwide. Hemodialysis is more effective, patients live longer, they need more access operation. The optimal strategy for the order and sequence of the different type and localization of AV fistulas remains obscure. Based on internationally acclaimed guidelines, autogenous access should be performed whenever possible and the first operation of choice is the radio-cephalic fistula at the wrist, the second type is the elbow fistula. The area between the standard exposures means also good access area and its usage is not emphasized properly. At our department the performance of autogenous fistulas have always been favoured. Beside the wrist radio-cephalic and elbow fistulas a significant number of autologous forearm AV fistulas has been operated. Our aim was to study the short and long term results of the autogenous forearm fistulas at atypical anatomic positions. We also examined whether the patency rate is affected by different variables as diabetes mellitus, acute or chronic operative situation, the indication of surgery, the quality of thrill at the end of shunt creation, the diameter and quality of the vein. Between 1997 and 2005 we performed 1018 AV shunts in an academic tertiary care center. 97 autologous antebrachial AV shunts were performed. The average follow up time was 31.3 months. The primary patency rate was 97%, 92% and 63% at the end of the first, second and sixth years, respectively. The patency rate was not significantly affected by any of the examined variables mentioned above. The patency rate of the autologous antebrachial AV shunt is comparable to the wrist and elbow fistulas, so our results support the practice of performing fistula at this atypical localization. More proximal autologous fistulas and prosthetic graft implantation could be postponed, this way valuable time could be saved for the uremic patients.