Abstract 134: The Current Patency Rate of Autologous Arteriovenous Fistula in the Snuff-Box and the Risk Factors for Its Failure

Introduction: Autologous snuff-box arteriovenous fistula (sAVF) is the first choice procedure as the primary AVF for chronic hemodialysis at this institution. The patency of the autologous AVF in the forearm was reported to be 43% to 85% at 1 year and 40 % to 69 % at 2 years. However, little is known about the patency of sAVF alone to date. In addition, there is a paucity of evidence for risk factors of its failure. Objectives: The purpose of this study was to describe the patency of sAVF and to verify the risk factors for its failure. Methods: Clinical records were retrospectively reviewed in 185 patients (114 male and 71 female patients) who underwent sAVF creation at our institution between March 2011 and December 2016. The average age was 64 ± 14 years (range, 23 to 90 years). The sAVF was created in the left and right arms in 155 patients and 30 patients, respectively. Nine patients had collagen vascular disease (CVD). Results: The primary patency rates were 93.0%, 66.9%, and 59.0% at 1 month, 1 year, and 2 years after surgery, respectively. The secondary patency rates were 98.9%, 89.3%, and 85.4% at 1 month, 1 year, and at 2 years after surgery, respectively. On multivariate analysis, female gender ( P = 0.002), sAVF creation in the right arm ( P = 0.013), and steroid use ( P = 0.019) were the significant risk factors for the decreased primary patency rate. CVD ( P = 0.001) and steroid use ( P = 0.005) were the significant risk factors for the decreased secondary patency rate. Conclusions: The patency rate of sAVF in our institution was comparable to previously reported patency rates for the forearm AVF. A careful observation for sAVF is needed in patients with female gender, history of smoking, sAVF creation in the right arm, CVD, and steroid use.