PURPOSE: Wrist fistulas are increasingly difficult to establish in the aging hemodialysis population. We assessed fistula patency and occlusion rate in elbow fistulas compared with wrist and graft fistulas. METHODS: We analyzed all 104 fistulas created in all 68 patients who underwent hemodialysis during October 1993 at the St. Joseph General Teaching Hospital, Veldhoven, The Netherlands. Life-table patency and complications were analyzed for 31 elbow fistulas, 56 wrist fistulas, and 17 polytetrafluoroethylene or saphenous vein graft fistulas. RESULTS: The patency rate for elbow fistulas was 93% at 1 year and 80% at 3 years. Wrist fistulas had a patency rate of 76% at 1 year and 65% at 3 years. Graft fistulas had a poorer patency rate: 69% at 1 year and 62% at 3 years. There were significantly more failures in the wrist fistulas (p < 0.02). Thrombosis accounted for most fistula failures. Venous stenosis was the most frequent indication for revision. The high incidence of concomitant diseases was not related to fistula outcome. CONCLUSIONS: The elbow fistula performed better than the wrist fistula. Liberal use of the elbow fistula is justified, especially when the epifascial veins or the radial artery at the wrist is in poor condition. Graft fistulas should be reserved for tertiary procedures.
PURPOSE: Wrist fistulas are increasingly difficult to establish in the aging hemodialysis population. We assessed fistula patency and occlusion rate in elbow fistulas compared with wrist and graft fistulas. METHODS: We analyzed all 104 fistulas created in all 68 patients who underwent hemodialysis during October 1993 at the St. Joseph General Teaching Hospital, Veldhoven, The Netherlands. Life-table patency and complications were analyzed for 31 elbow fistulas, 56 wrist fistulas, and 17 polytetrafluoroethylene or saphenous vein graft fistulas. RESULTS: The patency rate for elbow fistulas was 93% at 1 year and 80% at 3 years. Wrist fistulas had a patency rate of 76% at 1 year and 65% at 3 years. Graft fistulas had a poorer patency rate: 69% at 1 year and 62% at 3 years. There were significantly more failures in the wrist fistulas (p < 0.02). Thrombosis accounted for most fistula failures. Venous stenosis was the most frequent indication for revision. The high incidence of concomitant diseases was not related to fistula outcome. CONCLUSIONS: The elbow fistula performed better than the wrist fistula. Liberal use of the elbow fistula is justified, especially when the epifascial veins or the radial artery at the wrist is in poor condition. Graft fistulas should be reserved for tertiary procedures.