Kirurgisk anlagt arteriovenøs fistel i overekstremiteter og relaterte komplikasjoner

Abstract BACKGROUND: The need for vascular access for hemodialysis is steadily increasing with the increasing number of patients with end-stage renal failure. A surgically constructed arteriovenous fistula (AVF) is the golden standard and preferred vascular access for hemodialysis. AVF has a better primary patency rate as well as lower morbidity and mortality as compared to the arteriovenous grafts and central venous catheters. However, there are a number of complications related to fistula creation, with thrombosis and stenosis accountable for the most of the complications. Our aim is to conduct a critical appraisal of the literature related to AV-fistula primary patency the last 5 years. METHOD: We conducted a systematic search in PubMed, limited to the last 5 years and only English-language studies. We collected the data about the primary patency, stenosis and thromboses etc. RESULTS: After reviewing the title and abstracts of 315 citations, 271 were excluded. Only 25 of the 44 included studies were available in full text. We found two articles with systematic reviews and meta-analysis, which were published in 2014 and 2016, and decided to build our paper based on these two. “Complications of the Arteriovenous Fistula: A Systematic Review” found median complication rates per 1000 patient days as follows; thrombotic events 0.24, infections 0.11, steal syndrome 0.05, aneurysms 0.04 and venous hypertensive events 0.03. “Patency Rates of the Arteriovenous Fistula for Hemodialysis: A Systematic Review and Meta-analysis found that the rate of primary failure was 23 %, with a higher risk among elderly and patients with lower-arm fistulas. When primary failure was included, the primary patency rate was 60 % at 1 year and 51 % at 2 years. CONCLUSION: The studies gave an overview of common complications related to AVfistula ,with thrombosis being the most frequent one. Although primary failure rates have increased in the last decades, the primary patency rates are quite stable. There is a need for better quality of each single study, such as better reporting and standardized definition