Intraoperative pneumatic tourniquet use may improve the clinical outcomes of arteriovenous fistula creations

Abstract

Objectives: A major pathology affecting the usability of arteriovenous fistulas for hemodialysis is juxta-anastomosis stenosis. Intraoperative pneumatic tourniquet eliminates the use of vascular clamps, reduces vascular trauma, and may then reduce the juxta-anastomosis stenosis. The aim of this study was to compare the outcomes of arteriovenous fistula creations using the tourniquet-assisted approach versus the clamp-assisted approach. Methods: This retrospective study analyzed the outcomes of primary arteriovenous fistulas created by the lead author from 2008 to 2017 and met the specified inclusion criteria applied to both groups. Results: A total of 575 patients were included. Upon comparing the tourniquet group ( n = 411) with the clamp group ( n = 164): the primary arteriovenous fistula failure rate was significantly lower (2.4% vs 7.3%, p = 0.01); the percentage of arteriovenous fistula used for hemodialysis without initial interventions was significantly higher (71.5% vs 45.1%, p < 0.001) and with initial interventions was conversely lower (26.0% vs 47.6%, p < 0.001); the primary patency rate of the whole fistula conduits was significantly higher (44.2% vs 23.0% at 1 year, p < 0.001) and so was the cumulative patency rate (97.2% vs 92.6% at 1 year, p < 0.001); and the juxta-anastomosis primary patency rate (free of interventions for the juxta-anastomosis region) was higher (71.0% vs 47.8% at 1 year, p < 0.001). Based on multivariate Cox proportional hazards regression analyses, the effect of tourniquet use on the juxta-anastomosis primary patency remained significant (hazard ratio = 2.24, 95% confidence interval = 1.72–2.93, p < 0.001) when other significant factors (fistula location, gender, and diabetes) were considered. Conclusion: Intraoperative pneumatic tourniquet may significantly improve the clinical outcomes of arteriovenous fistula creations by reducing juxta-anastomosis trauma and subsequent stenosis.