Limitations of the use of arteriovenous fistulae in the cubital fossa.

A retrospective analysis of 88 patients operated upon with an arteriovenous fistula in the cubital fossa was made. At operation the intention was to construct a side-to-side fistula between a suitable vein and the brachial artery with an anastomosis length of 7-9 mm. 17 fistulae (19%) failed within three months, mainly due to occlusion. After one and four years, respectively, one-half and one-third of the fistulae at risk were in use. Patients with polycystic kidney disease had a worse prognosis regarding fistula function as well as those operated on with side-to-end technique. A patent cephalic vein in the upper arm was a favourable condition. Diabetic patients had a high risk of developing ischemia of the hand (25%), while this risk was low for patients with other diagnoses. Only one case developed heart decompensation, and 3 needed a flow reducing procedure. The method is thus less likely to function well in diabetics and in patients without a patent cephalic vein at the upper arm.