1Michael Parker,1Baljeet Dhillon, 1Baljeet Dhillon, 1Tariq Ali
1Norfolk & Norwich University Hospital NHS Trust
There is a paucity of evidence to support the use of fistulaplasty to optimise and maintain vascular access at different lesion sites.
Material(s) and Method(s):
All patients undergoing fistulaplasty at a single-centre, tertiary vascular centre between 13/01/2015 and 21/09/2019 were included in the study. Baseline characteristics were recorded, and factors associated with Primary- and secondary patency rates were investigated.
206 patients (88male, 118 female) mean age 68(14) years underwent fistulaplasty. Prevalence of diabetes, ischaemic heart disease & antiplatelet usage were 33.3%, 21.4% and 69.9% respectively. The median number of fistulaplasties performed per access during the follow up period was 2[1-3]. 65 fistulae were radiocephalic, 102 brachiocephalic, and 39 brachiobasilic transposition. 60 patients underwent a previous fistulaplasty before the study period, which we have termed recurrent stenosis (RS) and 146 were de novo stenoses (DNS). Stenosis location differed significantly between RS and DNS (p=0.03), with DNS primarily being anastomotic and RS prevailing in central and mixed locations. Younger fistulae were significantly more likely to have anastomotic stenoses than fistulae aged >1 year (p=0.001). These findings did not translate into statistically significant difference in primary patency, yet differences in SP were found by location of stenosis: Central 32[13-42] months, Fistula vein 20[12.5-35.5] and Mixed (n=33) 25 [13.5-37.5] months, Anastomotic 19[7-29.5], p=0.012.
Fistula stenosis location is associated with the age and type of fistula. The failure of younger fistulas is usually secondary to anastomotic stenoses, and that these stenoses have a lower secondary patency than stenoses elsewhere. Provisional data suggests that central stenoses which primarily occur in older fistulae have better secondary patency following fistulaplasty than stenoses at other sites.