Abstract :
This study reports our experience at the Chams Clinic, Sfax, Tunisia, with surgical revision of malfunctioning native arteriovenous fistula (AVF). The etiological diagnosis of inadequate access flow was determined by physical examination and a variety of clinical and physiological parameters. Between 1990 and 2006, surgical revisions were performed on 471 patients (mean age 52.8 years, 285 men and 186 women). There was radio-cephalic distal AVF malfunction in 299 patients (63%); the causes of malfunction in these patients included thrombosis in 47 and juxta-anastomotic vein stenosis or occlusion in 248 patients. The initial clinical success rate of all interventions was 98%. Post-intervention primary patency by Kaplan-Meier analysis at one, two, three, four, five and 10 years was 96%, 91%, 88%, 86%, 83% and 63%. Eighty-five patients had involvement of the brachial-cephalic proximal AVF. The post-intervention patency at six months, one, two and three years was 89%, 74%, 61%, 54% in these patients. There were 87 patients with the brachial-basilic upper arm AVF. The post-intervention patency at six months, one, two and three years was 94%, 84%, 64% and 55%. In conclusion, by surgical techniques, which are often simple, excellent results were obtained, and were much better than those obtained with angioplasty.
