Autogenous Arteriovenous Fistula: A Review

Since the introduction of the Brescia-Cimino surgical technique as access for chronic hemodialysis patient, a lot of modification of this technique has taken place. These were aimed at improving the utilization of autogenousarteriovenous fistula (AVF) by the patients with end stage renal disease (ESRD). The initial high primary failure rates lead to identification of some demographic, co-morbidity, anatomic and surgical factors that when corrected,contributed to the improve fistula patency and maturation rate. This review stressed the need for patient education, preoperative, intra-operative and post-operative modifiable factors that would increase the creation of autogenousarteriovenous fistula. It also stressed the value of creating brachio-cephalic AVF as the primary fistula for diabetic based on the peculiar nature of their vessels and their short life expectancy. The underlying pathological basis and management of common complications that could follow the various types of autogenous AVF is discussed. Autogenous AVF despite it constraint remains the cheapest and best vascular access for ESRD patient who require chronic hemodialysis. INTRODUCTION Worldwide there is an annual increase in the patients with end stage renal disease (ESRD) [1]. These patients are living longer and besttreated with one form of renal replacement or the other. The immediate option of management is hemodialysis that is best accomplished with a vascular access. There are three types of permanent vascular access namely; arteriovenous fistula (AVF),arteriovenous grafts (AVG) and cuffed tunneled central venous catheters (CVC). The CVC should be discouraged because it predisposes to infection and dysfunction [2]. In 1960, Quinton et al designed an external shunt for the maintenance hemodialysis but this was complicated by clotting and infection [3]. BresciaCimino et al. (1966) described the radiocephalic fistula, an internal shunt that gained popularity and has undergone a lot of modifications [4]. The arteriovenous graft (AVG) fistula made of polytetrafluoroethylene (PTFE) was introduced in 1969 and it accounts for 80% of primary vascular accesses created in the United States. The AVG is less frequently used in other countries. It has been recognized that the outcomes of PTFE grafts are poorer compared to autogenous AVFs [5]. AVG has a short life span and is more prone to recurrent stenosis and thrombosis. AVG often requires multiple salvage procedures to maintain its patency [6]. The preferred vascular access is autogenous AVF [7]. The autogenous AVF is reliable, has fewer complications [2, 8, 9,], often less infected and decreases mortality [10]. However, it has a high primary failure rate up to 50% in some centers [7, 11]. The brachiocephalic AVF (BC-AVF) and Autogenous Arteriovenous Fistula: A Review 1Takure AO, 1 Adebayo SA, 1Shittu OB and 2Salako BL 1Division of Urology, Department of Surgery, University College Hospital and College of Medicine, University of Ibadan, Ibadan 2 Nephrology Unit,Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan Corresponding author : Dr Takure Augustine O, Division of Urology, Department of Surgery, University College Hospital, Ibadan. E-mail: aotakure@yahoo.com&wveyin64@yahoo.com Tel: +234 (0) 803 393 1714 (Mobile) 87 Tropical Journal of Nephrology Vol.6 No2 December, 2011 87-95 Review Articles