Radiocephalic wrist arteriovenous fistula (RCAVF) is the primary and
best option for vascular access for hemodialysis treatment.
Aim of the study: The aim of this work is to evaluate new proximal radiocephalic
anastomosis as a surgical salvage procedure for failed functioning radiocephalic
arteriovenous fistula whether due to juxta-anastomotic stenosis or thrombosis.
Material and methods: A prospective study was done on 46 patients (21 males and
25 females) with chronic renal failure who had failed RCAVF due to juxta-
anastomotic stenosis (n=16) and thrombosis (n=30). diagnosis was made
clinically and by arterial and venous Duplex examination. The repair was performed
using a new proximal radiocephalic anastomosis in all cases. The patients were
followed up for 18 Illonths. Patency following surgical intervention was estimated
with the Kaplan-Meier method.
Results: Patients' age ranged from 1 8 to 70'years with a mean age of 44±12 years. The
technical success rate was 100%. Successtill utilization was achieved in 93.5%, i.e.
100% (16/16) for stenosed and 90% (27/30) for thrombosed arteriovenous fistulas
(AVFs). The time needed to use AVF after surgical proximal neoanastemoses ranged
from one week to four weeks. Primary patency of the neoanastomoses after 3, 6, 9,
12, 15 and 18 months were 89%, 80.4%, 78.3%, 73.9%, 67.4% and 63%, respectively.
There was no statistically significant difference in the primary patency of the
neoanastomosis between those performed for stenosed and thrombosed fistulas (P •
Conclusion: In our experience, in patients with failed functioning radiocephalic
arteriovenous fistulas whether due to juxta-anastomotic stenosis or thrombosis and
have a suitable cephalic vein proximal in the forearm we can salvage the failed fistula
by proximal neoanastomosis with excellent technical success, early utilization, low
complications and suitable primary patency.