Fistula vs. Catheter

February 3, 2008 at 1:33 am

Here’s my thinking on having a fistula or catheter. First, let me list the pros and cons of each, as I see them. The pros of catheters are that Easier surgery and Immediate use. The cons are that they have a relatively short lifetime, have a relatively high risk of infection, require maintenance, and have a potential for life threatening complication (thrombosis or physical damage). The pros of fistulas are that they have a longer lifetime, have a low infection risk, and require little maintenance. The cons are that the surgery is more difficult, they take 8 to 12 weeks to heal sufficiently to be used, and they have a potential for life threatening complication (thrombosis or rupture)

[COLOR=black]Why have a catheter ever? Well, if you need PP now, because your symptoms are progressing rapidly, a fistula is not an option. Otherwise, it is a question of managing treatments over the long haul. If one is 50 or younger, then one must manage vascular access for 30 to 40 years. For me, I think that the catheter I have now will probably last 3 to 4 years. It is then possible that I could have a replacement installed. Let’s say it does as well. I could have another two catheters installed in a different location, and let’s say those also last 4 years each. In sum, I could probably have catheters until my mid 60’s. At that point, I should be at the point where the risk of the fistula surgery will be low enough, but the risk of infection just do to age will start to be increasing. Fistulas can last seven years or so. I could then have one in my early 70’s, assuming reasonable health, one in my late 70’s, and one in my mid-80’s.[/COLOR]

[COLOR=black]Why not switch to fistula now? Because there is a limit to the number one can have. If I exhaust those, I would be using catheters in my 70’s and 80’s. I would rather have the lower infection risk then and the problems of a catheter now. Also, because there is some history of dementia in both my wife’s families and mine, I would rather have something easy to take care of later, just in case. [/COLOR]

[COLOR=black]This choice is really a personal one. Fistulas (and the grafts that Flower mentioned) do work very well, and are the preferred alternative for dialysis. It is just that CIDP’ers who might use PP for 30 to 40 years are in uncharted territory. I think DocDavid has been on dialysis for 6 to 10 years. Maybe he or other long-term dialysis users can give us a better perspective on long-term vascular access.[/COLOR]