Complications of hemodialysis access in HIV-positive patients.

As long-term arteriovenous (AV) access for hemodialysis becomes more prevalent in human immunodeficiency virus (HIV)-positive patients it is important to evaluate the complications associated with each surgical technique. The records of 37 consecutive HIV-positive patients undergoing surgery for AV hemodialysis access were reviewed. Cases were analyzed for age, gender, presence of acquired immunodeficiency syndrome (AIDS), surgical procedure, and complications. AV fistulas were performed primarily in 23 patients, and prosthetic grafts were used in 14. There was no difference between these two groups in regard to age (P = 0.510), gender (P = 0.620), or presence of AIDS (P = 0.97). Complications requiring one or more reoperations occurred in four patients (17%) after AV fistulas and in seven patients (50%) after AV grafts (P = 0.035). When reoperations were accounted for a total of 28 AV fistulas and 20 AV grafts were performed with an overall complication rate of 21 and 70 per cent respectively (P = 0.001). Complications after AV grafts included thrombosis (40%), infection (25%), and aneurysm (5%). Thrombosis was the only complication observed after AV fistula (21%). The complication rate after AV access in HIV-positive patients was significantly greater after AV graft insertion than after AV fistulas, which resulted in a higher rate of reoperation. AV fistula when feasible should be considered the procedure of choice in this group of patients.