ARE THERE DIFFERENCES IN ARTERIOVENOUS FISTULAE CREATED FOR HEMODIALYSIS BETWEEN NEPHROLOGISTS AND VASCULAR SURGEONS?

Stolić, Radojica V; Bukumiric, Zoran; Mitrovic, Vekoslav; Sipic, Maja; Krdzic, Biljana; Relic, Goran; Nikolic, Gordana; Sovtic, Sasa; Suljkovic, Naja E

OBJECTIVE Arteriovenous fistulae can be a reason for frustration among nephrologists dependent on surgeons. This is why nephrologists in many centers have begun to create arteriovenous fistulas themselves. The aim of this study was to determine possible differences and predictive parameters for arteriovenous fistula function in patients whose fistulas were created by a nephrologist or a vascular surgeon. METHODS The study was organized as a retrospective, descriptive-analytical study of interventions by nephrologists and vascular surgeons during a period of 15 years. The total number of arteriovenous fistulae created by surgical interventions in this interval was 1048. A nephrologist created them in 764 (72.9%) patients, while vascular surgeons were responsible for 284 (27.1%) fistulae. All laboratory, demographic, and clinical parameters which might affect functioning of these arteriovenous fistulae were analyzed. RESULTS Patients whose arteriovenous fistula was formed by the nephrologist differed significantly from those created by vascular surgeons in relation to positioning of the anastomosis (p <0.001), the preventive character of the arteriovenous fistula (p <0.001), lumen of the vein (p = 0.004) and systolic blood pressure (p = 0.02). Statistically significant predictors of arteriovenous fistula dysfunction, in the multivariate logistic regression model, were female gender (B = 0.439; p = 0.003), who created the fistula (vascular surgeon or nephrologist) (B = 0.325; p = 0.041), and the site of the arteriovenous fistula (B = -0.454; p = 0.002). CONCLUSION Arteriovenous fistulae created by vascular surgeons, female gender and the location are predictors of dysfunction.