ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 317-320

Learning curve for arteriovenous fistula creation


1 Department of Urology, University Hospital Merkur, Zagreb, Croatia
2 Department of Vascular Surgery, University Hospital Merkur, Zagreb, Croatia

Correspondence Address:
Hrvoje Smojver
Department of Urology, University Hospital Merkur, Zagreb
Croatia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_59_21

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Objective: Amount of time and number of procedures required in junior surgeon (JS) to achieve arteriovenous fistula (AVF) patency rate of surgeon with 20 years of experience. Methods: A single-center, retrospective, case–control study of AVF primary patency rate at 1 year postoperatively was observed among junior and experienced surgeon (ES) over a 4-year period. Fistula was created by terminolateral anastomosis in a fashion of continuous suture with nonabsorbable double-armed 7-0 monofilament. Maturation was grounded on the physical examination and fistula ultrasound 6 weeks postoperatively. Results: One hundred and twelve patients, 65% male and 35% female, were included in the study in 4 year period, 2015–2018. There were 51% radiocephalic and 49% brachiocephalic fistulas constructed by JS. Patency rate for JS was 66% overall, combining 64% for radiocephalic and 67% for brachiocephalic, compared to ESs 79%, performing only brachiocephalic fistulas. In the first 3 years, patency rate was 63%, 60%, and 66%, while significant improvement was accomplished in the the 4th year with patency rate of 75%. Average time for hemodialysis initiation was 88 days postoperatively. Conclusions: Three years and approximately 60 procedures are required for JS to produce results comparable to ES in creation of AVF.


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