K-G Ljungström

Auditing surgical outcome: ten years with the Swedish vascular registry—Swedvasc

Auditing surgical outcome: ten years with the Swedish VascularRegistry--Swedvasc. The Steering Committee of Swedvasc.

Outcome assessment in vascular surgery – the Swedish experience

Outcome assessment in vascular surgery - the Swedish experience. The Steering committee of Swedvasc.

Time-trends in Vascular Access Surgery in Sweden 1987–2006

OBJECTIVE To study time-trends in vascular access surgery. DESIGN Prospectively registered data. MATERIAL AND METHODS The Swedish vascular registry (Swedvasc) was searched for haemodialysis access operations (HAO) 1987-2006. RESULTS 12,342 open and endovascular operations were identified. Eighty-five percent of HAO 2004-2006 were reported to the registry. The median age of patients having their first HAO increased from 56 to 68 during the first decade (p<0.0001), then remained stable. The frequency of diabetes increased from 12% in 1987 to 32% in 2006 (p<0.0001). The percentage of first HAO of total workload decreased from 76% to 48%. The percentage of first HAO performed as vein fistulas remained unchanged. The number of patients recorded for ten or more previous HAO increased over time. Percutaneous angioplasties increased during the last decade. Of 4706 patients operated on with primary radiocephalic AV-fistulas, 2933 (62%) were operated only once. Analysis of 3739 subsequent operations in 1773 patients disclosed that at the tenth operation vein was still used in 54%. With an increasing number of operations, arterial inflow shifted towards a more proximal position. CONCLUSIONS Over time, the patients undergoing HAO became older and more often diabetic, reoperations increased. Despite these circumstances, vascular surgeons perform AV-fistulas without grafts in most patients.