Özet:

Primary failure of arteriovenous fistula (AVF) is a serious problem. For decreasing the failure rates, pre-operative ultrasonographic evaluation of the target vessels is popular in recent years. However, in most clinics ultrasonographic evaluation is not routine. Operation is usually performed after physical examination. The aim of this study is to evaluate the primary failure reasons and the relation between vessel diameters and primary failure. 448 operations, including AVF creation, revisions and closures performed between 01.01.2012-31.12.2015 were evaluated retrospectively. Age, gender, race, site, side, operation, reason(s), used artery and vein, diameters, anastomosis type, thrill, patency and co-morbid diseases evaluated. Patencies were controlled on the 10th day, on the 1st, 6th months, 1st and 2nd years. Of the 448 operations, 86.38% was creation, 3.79% was closure and 9.82% were revision. Leading revision reason and performed procedure was thrombosis (56.81%) and thrombectomy. Leading reason of closures was ischemia (35.29%). Mean brachial artery diameter was 4.45±0.45 mm and mean radial artery diameter was 2.52±0.42 mm. Mean vein diameters were 3.31±0.60 mm for basilic vein and 2.47±0.64 mm for cephalic vein. In patients with less than diameter of 4.45 mm for brachial artery (p<0.003) and less than diameter of 2.15 mm for cephalic vein (p<0.005), dysmaturation or failure rates were significantly higher. Preoperative ultrasonographic evaluation of the vessels is a good choice even if the physical examination of the patient is good. We recommend min 4.45 mm brachial artery, min 2.15 mm cephalic vein and min 2.20 mm radial artery diameter. Presence of thrill at the end of the AVF creation is an important marker for an adequate, long lasting AVF. 

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