Abstract presented at the 2000 ASN Annual Meeting in Toronto.

SUCCESSFUL CONVERSION OF DIALYSIS GRAFTS INTO SECONDARY AV FISTULA. A THREE YEARS EXPERIENCE AT PROVIDENCE ST PETER HOSPITAL DIALYSIS PROGRAM, Vo Nguyen1,,Chris Griffith2. 1Nephrology, Memorial Clinic; 2Surgical Associates, Olympia,WA

The types of permanent hemodialysis (HD) vascular access currently in use are the native arteriovenous fistulae (AVF) and the PTFE AV graft (G). Most previous studies have suggested an improved survival of AVF compared to G. G thrombosed frequently. Furthermore, the majority of thrombosed G will fail again after revascularization ( either by endovascular or surgical methods) within 6-12 months. Unfortunately, only 21% of HD patients in the US currently have an AVF. Since 1996 we have stopped revising failing or thrombosed G and have used the ipsilateral arterialized veins to successfully create secondary AVF.

A total number of 17 patients were reviewed, age: 69.7 (SD 8.3), 65% female, 35% male, 65% diabetes mellitus, 82% peripheral vascular disease. A total of 17 AVF were created, number of surgical procedures by a single general surgeon: 17. Success rate was 100%. Of the AVF, 5% was radiocephalic, 59% brachiocephalic, 35% brachiobasilic. 41 % of all AVF were transposed. The diameter of the preop veins as measured by Doppler or physical exam: 4.8mm (SD 1.1). All AVF were cannulated successfully 34.4 days (SD 25, range: 1 to 56 d) after its placement. Steal syndrome was present in 18%, none requiring ligation of AVF.

Conclusion: preexisting G lead to arterialization and dilatation of many veins in ipsilateral arm and greatly facilitate the creation of secondary AVF. The surgical success rate was 100% in our experience despite high morbidity factors among our patients. This suggests that we should stop revising failed G routinely and concentrate our efforts instead on creating secondary AVF in ipsilateral arm. If most G in the US are converted to AVF, HD units could achieve the goal of 60-70% of AVF instead of the 40% as recommended by DOQI Guidelines.

e-mail: vdnguyen9@pol.net