Hemodialysis Vascular Access and Complications

From January, 1985, to July, 1991, 105 uremic patients had 148 vascular accesses for chronic hemodialysis. Thirty-three (31.4%) patients received more than one access. Of 148 accesses, 131 (88.5%) were arteriovenous (AV) fistulae and 17 (11.5%) were AV grafts. The mean hospital stay for patients with AV fistula was twenty-four days and for those with polytetraflouroethylene (PTFE) graft was thirty-five days. The maturation period for fistulae and grafts was six to eighty-one days and two to forty-five days respectively Early postoperative complications included death in 1 patient, major bleeding in 6 (4.6%) fistulae and primary failure in 28 (21.4%) fistulae and 2 (11.8%) grafts. Deep vein thrombosis occurred in the upper limb of 1 patient with AV graft, and ischemic manomelic neuropathy developed in 1 patient with AV graft. Late complications included bleeding in 6 (4.6%) fistulae and 4 (23.5%) grafts, ischemia in 2 (0.15%) fistulae and late failure due to thrombosis in 19 (14.5%) fistulae and 7 (41.2%) grafts. Infection of the access occurred in 18 (13.7%) fistulae and 14 (82.3%) grafts and led to death in 1 patient. AV fistulae patency rate was 80% after one year and 67% after five years. The patency rate for AV grafts was 67% after one year and 48% after five years.