Standard protocol for creation of upper extremity arteriovenous fistulae


Marwan Tabbara, vascular surgeon at the University of Miami Health System, reported using a standard protocol on 855 upper extremity fistulae created over a 10 year period. The findings suggest the use of a standard protocol for creation and management of arteriovenous fistulae can help increase the rate of functional access over the national benchmarks. Additionally, extension/conversions of a malfunctioning fistula to grafts appear to be an excellent method to expedite removal of a tunneled dialysis catheter with concomitant preservation of a fistula.

The full study can be found in the June 2013 issue of The American Surgeon: “Analysis of 855 upper extremity fistulas created using a standard protocol: the role of graft extension to achieve functional status.”

Using Artegraft Bovine Carotid Artery Graft as graft extensions resulted in an increase in the functional fistula access rate by 30% to help accomplish a total functional fistula access rate of 79.8%.

Artegraft was utilised to salvage malfunctioning or short fistulae at the venous outflow. Each fistula was followed for one year. Functional status was achieved if haemodialysis could be performed using the access for at least three months after cannulation. 

“The natural benefits of Artegraft closely mimic those of a native fistula, providing enhanced patient outcomes for hemodialysis access patients,” stated Rick Gibson, president and CEO, Artegraft.

Bovine Carotid Artery Graft technology consists of a biological collagen cross-linked matrix, creating a flexible and compliant vascular conduit that closely matches a native vessel. Artegraft’s patency rates were previously reported to be clinically superior to ePTFE for arteriovenous access according to the published study in the June 2011 issue of the Journal of Vascular Surgery.