Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis

Abstract

This report describes our experience of arteriovenous fistula (AVF) creation as vascular access for hemodialysis (HD). Study has been carried out in Deenanath Mangeshkar Hospital, Pune from January 2004 to December 2009. A total of 271 AVFs were created in 249 patients. Maximum follow up was 7 years and minimum was 1 year. In this study of 271 cases of AVFs, there were 196 (72.3%) successful cases and 75 (27.7%) failures. Basilic vein was used in 77 (28.4%) cases, cephalic vein in 186 (68.6%), and antecubital vein in 8 (3%) cases. End (vein) to side (artery) anastomosis was done in 170 (63%) cases. Side to side anastomosis was done in 100 (37%) cases. On table bruit was present in 244 (90%) and thrill in 232 (85.6%) cases. During dialysis, flow rate >250 ml/min was obtained in 136 (50.4%) cases. In complications, 16 (5.9%) patients developed distal edema, 32 (11.8%) developed steal phenomenon. Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. During proximal side to side fistula between antecubital/basilic vein and brachial artery, breaking of first valve toward wrist helps to develop distal veins in forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in arm.

Creation and outcome of arteriovenous fistula for hemodialysis: experience in a tertiary care hospital in Saurashtra, Gujarat

“…A majority of patients in this study were males (76%). This finding is consistent with that reported by Sahasrabudhe et al 5 and Sahin et al1. They reported that there were 65.7% and 62.07% males in their study respectively.…”

A Retrospective Analysis of Arteriovenous Fistulas as Hemodialysis Access Surgery in the Perspective of KDOQI (Kidney Disease Outcomes Quality Initiative) Guidelines

“…American Institute of Ultrasound in Medicine Practice Guideline revised in 2011 states that the lumen diameter of artery below 2 mm and vein diameter below 2.5 mm lead to higher failure rates [6]. We think that colored Doppler ultrasound is not so helpful in evaluating the vessels in the arm, from our previous experiences.…”

Vascular access and its complications in patients with chronic kidney disease on haemodialysis: a retrospective analysis

“…15 In another study, majority of patients with AVF had steal phenomenon and distal edema. 13 Another study reported most common complication in patient with AVF was thrombosis (30.5%). 6 Another study reported data of 96 patients with 104 femoral catheters used for 1 to 26 days.…”

“…Eighty-one fistulas were constructed on right side and 190 were on left side. 13 One eighty-seven patients had AVF on radial artery and 84 had AVF on brachial artery. 13 In general, when AFS are planned, non-dominant limb preferred, for example, if the patient is right-handed, left arm is preferred.…”

“…These complications are similar to previous reports. 6,[9][10][11][12][13][14][15][16][17] The complications reported by Mahakalkar et al in patients with AVF were oedema, infection, bleeding at operative site, ecchymosis at the operative site.14 However, Susan et al reported early complications as thrombus, haematoma, bleeding and wound infection, and late complications as thrombosis, pseudoaneurysm. 15 In another study, majority of patients with AVF had steal phenomenon and distal edema.…”