The snuffbox fistula should be preferred over the wrist arteriovenous fistula

J Vasc Surg. 2016 Feb;63(2):436-40. doi: 10.1016/j.jvs.2015.08.104. Epub 2015 Oct 23.

Abstract

Objective: The snuffbox arteriovenous fistula (SBAVF) is the most distal native vascular access. Although published data show a favorable outcome, the SBAVF is not strongly recommended by the guidelines. The present study compared the patency of SBAVFs and wrist AVFs (WAVFs).

Methods: All 416 AVFs created by the same nephrologist from March 2006 to October 2014 were reviewed. From 416 procedures, 47 SBAVFs and 77 WAVFs with vessels suitable for a SBAVF were selected.

Results: Although vessel diameters used for construction of the SBAVFs were smaller than those used for WAVFs, the outcome of vascular access was similar. At 18 months, primary patency was 72% for SBAVF and 65% for WAVF (P = .48), and secondary patency was 93% for SBAVF and 94% for WAVF (P = .89).

Conclusions: In our experience, a SBAVF performs as well as a WAVF up to 18 months after creation. We suggest favoring SBAVF, especially in young patients without comorbidities, as the primary vascular access.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arteriovenous Shunt, Surgical / adverse effects
  • Arteriovenous Shunt, Surgical / methods*
  • Comorbidity
  • Female
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Radial Artery / physiopathology
  • Radial Artery / surgery*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Patency
  • Veins / physiopathology
  • Veins / surgery*
  • Wrist / blood supply*
  • Young Adult