Abstract:

Objectives: to investigate which kind of native arterious-venous fistula guaranteed the best results in diabetic patients.

Methods: A retrospective case-control study with prospective follow-up was conducted on all consecutive patients undergoing creation of the first native vascular access (VA) at our Institution between January 2011 and December 2016. Patients were divided into two groups: diabetics (Group A) and non-diabetics (Group B) and results were evaluated according to site chosen for VA creation. Primary outcomes were maturation and primary patency rate. Secondary outcomes were complications, rate of functional fistulas and mortality.

Results: A total of 410 patients (n 155, 37.8% female; n 255, 62.2% male; mean age 64.21±14.85 years, range 58-78) were divided into two non-statistically different groups (Group A: n 170, 41.5%) and Group B: n 240, 58.5%) . Maturation and primary patency were statistically different for ante-brachial (p=0,038 and p=0.044 respectively), but not for brachial access (p=1 and p=0.080 respectively) at 3 years. Hyper-flow and steal syndrome rate didn’t differ between the two sites and groups. At a mean follow-up of 42.86 months (range 1-72) five patients died. Diabetics demonstrated the higher rate of overall complications at the long-term follow-up.

Conclusion: Diabetes mellitus plays a detrimental role in maturation and primary patency of ante-brachial fistula, however brachial fistulas results do not differ between diabetics and non-diabetic patients. More robust data and longer-term results from randomized studies are needed to affirm brachial fistula as preferential access in diabetic patients.

Reference:

Borghese O, Pisani A, Lajmi M, Di Centa I. Tailoring hemodialysis vascular access in diabetic patients. Ann Vasc Surg. 2020 Nov 25:S0890-5096(20)31005-0. doi: 10.1016/j.avsg.2020.10.021. Epub ahead of print. PMID: 33248239.