AV Fistula Results

An arteriovenous fistula (AVF) is considered by most to be the best type of vascular access for hemodialysis. The main advantages of AVFs are fewer infectious complications, fewer procedures needed to maintain patency, and longer duration of function. The major disadvantages are, of course, a lower maturation rate than grafts (AVG) and a longer time until ready to use. Maturation rates should be at least 60% for radiocephalic AVF (RCAVF) and around 80% or more for both brachiocephalic AVF (BCAVF) and brachiobasilic AVF (BBAVF). When all cases are included, including those that fail to mature, 1-year primary patency rates are probably around 40% for RCAVFs, 65% for BCAVFs, and 60% for BBAVFs, although cumulative or secondary patency, which incorporates successful salvage, will be better. Some quote significantly higher success rates, but many such claims fail to include primary failures. In fact, when primary failures are included (“intent to treat” analysis), overall results approach those of prosthetic. The best approach for the vascular access patient is obviously to individualize access choice based on these and other factors, rather than to just follow a “one size fits all” rule.