Abstract: Objective To compare vascular access and complications between improved elbow arteriovenous fistula (AVF) and traditional elbow AVF in maintenance hemodialysis patients. Methods Eight-four patients with improved elbow AVF surgery and 79 patients with traditional elbow AVF surgery were followed up
for 4 years. Fistula diameter, vascular length useful for blood access, average blood flow, and fistula patency during dialysis period were compared between the two groups. Thrombus, aneurysm, forearm edema, heart failure were recorded to evaluate complications in the two groups. Results Both of the two kinds of AVFs met the requirements for hemodialysis. In improved elbow AVF group and traditional elbow AVF group after the surgery for 3 months, the average blood flow was 1101.66±189.66 ml/min and 1199.46±197.23 ml/min (P =0.002), respectively; vascular length available for blood access was 20.59±1.63 cm and 15.24±1.17 cm (P＜0.001), respectively; blood vessel diameter was 6.30±0.59 mm and 6.20±0.62 mm (P =0.284), respectively. The fistula patency rate was similar (P＞0.05) in the first two years between the two groups, but was higher (P=0.045) in the first three years in the improved elbow AVF group. The incidence of thrombosis was higher in traditional elbow AVF group (P=0.047), but the incidence of forearm edema was higher in improved elbow AVF group (P=0.037). The incidence of heart failure and aneurysm were similar between the two groups (P＞0.05). Conclusions Both of the two groups yielded sufficient blood flow and higher patency rate. The improved AVF surgical method obtained longer vessel for blood access but with higher rate of forearm edema.

Key words: Improved, Arteriovenous fistula