Clinical profile and early outcome of arteriovenous fistula creation for Haemodialysis: Integrated activity in a general surgery unit (original) (raw)
Related papers
Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis
Indian Journal of Nephrology, 2013
presence of on table bruit and thrill, role of postoperative anticoagulants and suture used to postoperative outcome and patency. Materials and Methods This retrospective observation study was carried out in our institute in patients who underwent surgical AVF creation between January 2004 and December 2009. During this period, AVF was created in 421 patients but we could follow up only 249 patients during January to July 2011. Follow up was obtained in collaboration with dialysis unit staff by telephonic calls and personal visits to the patients. The data extracted from hospital records included patient demographics, co-morbidities, details of previous access, location and type of AVF, operative details, patency, morbidity, and mortality. The data collection was difficult and took time of 6 months as some patients were taking dialysis at some other centers. Some were lost to follow up and others could not be reached. A total of 271 AVFs were placed in 249 patients. Maximum follow up was 7 years and minimum follow up was 1 year. Twenty-two patients required repeat procedure due to failure of previous fistula. This is single center, single surgeon retrospective study comparing preoperative vein and artery diameters,
Outcomes of Arteriovenous Fistula Creation in Patients Undergoing Hemodialysis: An Indian Experience
Cureus, 2022
Introduction Creating an arteriovenous fistula (AVF) to provide a patent and long-term vascular access (VA) for hemodialysis (HD) still remains a challenge. A methodical approach to choosing the appropriate HD access in accordance with patients’ end-stage kidney disease (ESKD) life plan will help them achieve their goals safely. This study summarizes the impact of various factors on the AVF outcomes in an Indian population as well as the necessary considerations before choosing the site of AVF creation. Materials and methods This study involved a single-center, retrospective evaluation of all patients who had undergone arteriovenous (AV) access creation for maintenance HD from October 2018 to August 2019 at a center in India. Results In our study of 216 cases, the average age at presentation was 43.9 years and the difference in age between the successful and unsuccessful group was not significant. The successful outcomes in males were significantly higher than those in females (p=0....
Arteriovenous Fistula Creation for Hemodialysis: Evaluation of Complications
2021
Background: Vascular access care is a classic example of multidisciplinary team work among nephrologists, vascular surgeons, duplex specialists, dialysis nurses and dialysis staff. The objectives of this study were to determine the complication of arteriovenous fistula (AVF) for hemodialysis (HD) and to find out the role of duplex study for the management of fistula complications. Methods: This was a prospective type of study done on 121 arteriovenous fistulas. All operations were done in different hospitals in Dhaka city. After duplex study of upper limb vessels, the site of fistula creation was determined. All Radio-cephalic, ulnar-basilic and brachiocephalic fistulas were done under local anesthesia. Other fistula of the series was done under brachial block. Immediate postoperative bruit, thrill and distal pulses were monitored. Fistulas were considered mature after at least 6 weeks of fistula creation with good visualization of arterialized vein and good thrill. Patients were ad...
International Surgery Journal, 2016
INTRODUCTION Hemodialysis fistulas are surgically created communications between an artery and vein in an extremity.Several studies indicate that about 30% of hospitalizations are caused by construction and complications of vascular access. 1 Direct arteriovenous communications are called native arteriovenous fistulas. Prosthetic hemodialysis access arteriovenous grafts can also be used as a means of communication between an artery and vein. The access that is created is routinely used for hemodialysis. The AVF was first described and used as a reliable form of hemodialysis (HD) vascular access by Brescia et al in 1966. 2 A shift in the treatment of hemodialysis patients occurred when James EC et al noted that arteriovenous fistulas caused by trauma in Korean war veterans did not have significant effects on their health and this lead to his proposal that ABSTRACT Background: The study was conducted to assess the various complications which are encountered while creating arteriovenous fistula and post operatively during the period when fistula matures. Also the study was intended to study the failure rate and the importance of physical examination to assess vessel caliber clinically. Methods: The study comprised of 83 patients suffering from chonic renal failure and requied arteriovenous fistula for carrying out hemodialysis. The arteriovenous fistulas were created under local anesthesia, observing all precautions and end to side anastomosis was made after dissecting the vein and the artery. Results: The most common difficulty encountered at surgery was when cephalic vein was of very small caliber and we had to give a small longitudinal incision in the wall of vein or do cheatle manouvre to make the anastomosis adequate. In five cases we started for radiocephalic fistula but had to convert to brachiocepphalic fistule as arteriovenous anstomoosis was not possible between the radial artery and the cephalic vein. There were no major complications except redness and inflamation in five cases and pus formation in one case. Inflamation subsided with higher antibiotics and pus had to be drained resulting in satisfactory recovery.Most of the fistulas started well with good thrill and by the end of one month 69 out 83 arteriovenous fistulas were functioning well with a patency rate of 83.13%. Conclusions: There are no major complications after creating arteriovenous fistula and it is imperitive to do physical examination preoperatively to assess the vessel wall. In doubtful cases color Doppler may be got done for this. Postoperative precautions need to be observed for maturation of AV fistula.
Preoperative management of arteriovenous fistula (AVF) for hemodialysis
The journal of vascular access, 2017
Native arteriovenous fistula (AVF) is the favorite access for hemodialysis (HD). The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) recommends its creation in most patients with renal failure. Unfortunately, intensive efforts to promote native AVF in patients with marginal vessels have increased the rate of primary fistula failure. A non-functioning fistula prompts the use of central venous catheter (CVC) that, unlike AVF, has been associated with an increased risk of morbidity and mortality among patients receiving HD. We believe that successful and timely AVF placement relies on the development of a multidisciplinary integrated preoperative program divided into five stages: (i) management of patients with advanced chronic kidney disease (CKD), (ii) management of preoperative risk factors for AVF failure, (iii) planning of native AVF, (iv) assessment of patient eligibility and (v) preoperative vascular mapping. Focusing specifically on native AV...
[Arteriovenous fistulas for hemodialysis in patients with chronic renal failure]
Polski przeglad chirurgiczny, 1977
INTRODUCTION Hemodialysis fistulas are surgically created communications between an artery and vein in an extremity.Several studies indicate that about 30% of hospitalizations are caused by construction and complications of vascular access. 1 Direct arteriovenous communications are called native arteriovenous fistulas. Prosthetic hemodialysis access arteriovenous grafts can also be used as a means of communication between an artery and vein. The access that is created is routinely used for hemodialysis. The AVF was first described and used as a reliable form of hemodialysis (HD) vascular access by Brescia et al in 1966. 2 A shift in the treatment of hemodialysis patients occurred when James EC et al noted that arteriovenous fistulas caused by trauma in Korean war veterans did not have significant effects on their health and this lead to his proposal that ABSTRACT Background: The study was conducted to assess the various complications which are encountered while creating arteriovenous fistula and post operatively during the period when fistula matures. Also the study was intended to study the failure rate and the importance of physical examination to assess vessel caliber clinically. Methods: The study comprised of 83 patients suffering from chonic renal failure and requied arteriovenous fistula for carrying out hemodialysis. The arteriovenous fistulas were created under local anesthesia, observing all precautions and end to side anastomosis was made after dissecting the vein and the artery. Results: The most common difficulty encountered at surgery was when cephalic vein was of very small caliber and we had to give a small longitudinal incision in the wall of vein or do cheatle manouvre to make the anastomosis adequate. In five cases we started for radiocephalic fistula but had to convert to brachiocepphalic fistule as arteriovenous anstomoosis was not possible between the radial artery and the cephalic vein. There were no major complications except redness and inflamation in five cases and pus formation in one case. Inflamation subsided with higher antibiotics and pus had to be drained resulting in satisfactory recovery.Most of the fistulas started well with good thrill and by the end of one month 69 out 83 arteriovenous fistulas were functioning well with a patency rate of 83.13%. Conclusions: There are no major complications after creating arteriovenous fistula and it is imperitive to do physical examination preoperatively to assess the vessel wall. In doubtful cases color Doppler may be got done for this. Postoperative precautions need to be observed for maturation of AV fistula.
Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia, 2015
The population of end-stage renal disease (ESRD) patients is rising all over the world. 1,2 In 2009, more than 350,000 patients in the United States (US) received in-centre haemodialysis (HD). Vascular access procedures are one of the most commonly performed surgeries in the US, with approximately 500,000 procedures performed annually. 3 Treating ESRD patients cost the US over $40 billion in public and private funds in 2009. 4 In Europe, more than 550,000 ESRD patients received renal replacement therapy (RRT) in 2010. 5 The prevalence of RRT per million population (p.m.p.) on 31st December 2009 was the highest in Portugal (1507 p.m.p.), Belgium, French-speaking (1193 p.m.p.) and Spain, Catalonia (1160 p.m.p.). 6 Despite an increase in the number of kideny transplants, which is the best treatment of ESRD patients, chronic HD is still the main therapy. 1 Autologous (native) arteriovenous fistula (AVF) provides the best access to the circulation because of low complication rate, long-term use and lower costs, compared to arteriovenous graft (AVG) and central venous catheter (CVC). 1,7,8 The cost of vascular access care was more than five times lower in those who had begun treatment with functioning AVF, compared to those who were * Corresponding author.
Late postoperative complications of arteriovenous fistula for hemodialysis
Биомедицинска истраживања, 2021
The vascular approach is a prerequisite for performing hemodialysis, but their "weak points" are different and frequent complications. Modern guidlines recommend native arteriovenous fistula (AVF) as the first choice of vascular approach, because it is characterized by the longest survival and the least complications compared to other vascular approaches. All complications of AVF can be divided into intraoperative, early, and late postoperative. This paper presents the late postoperative complications of AVF, their frequency, causes, diagnosis and treatment. The most important late postoperative complications are: stenosis, thrombosis, aneurysm or pseudoaneurysm formation, infection, hand edema, hematoma, ischemic steal syndrome, ischemic neuropathy, congestive heart failure. Large differences in the frequency of each complication in earlier studies can be explained by differences in surgical technique, localization of AVF, diagnostic methods, but, above all, differences between the presented groups of patients. It is described that the age of patients, sex, underlying disease, the presence of comorbid conditions and various metabolic and immune disorders characteristic of chronic renal failure, as well as the way of using and caring for AVF significantly affect the occurrence of AVF complications. One of the main predictors of AVF success and survival is the quality of the patients' blood vessels, and therefore careful examination of blood vessels before approaching AVF creation is of particular importance. The creation, use and care of AVF is the task of the team of health professionals who take part in the treatment of these patients, and successful treatment requires their good cooperation, as well as cooperation with patients.
Clinical Practice, 2016
Background: There is gradual increase in need for hemodialysis, as there is gradual increase in the end stage renal disease in India. Permanent vascular access in the patient with end stage renal disease on hemodialysis is provided through a central venous catheter, arteriovenous graft, or arteriovenous fistula. The aim of this study was to evaluate the site, results and postoperative complications of arteriovenous fistula creation in our hospital. Method: It was a retrograde study conducted at Seth Sukhlal Karnani Memorial (SSKM) hospital, Institute of PostGraduate Medical Education and Research (IPGMER), Kolkata, between 1st July 2006 and 30th August 2011. All patients, with end stage renal disease requiring long term vascular access for haemodialysis, were included in the study. In most of the patients radio-cephalic fistulae were created in the left forearm, in some on right forearm, just above the wrist joint, and in some patients brachiocephalic or brachiobasilic arteriovenous fistulae were created. Results: 375 patients were studied; 292 (77.86%) males and 83(22.14%) females, with male to female ratio of 3.52:1. Distribution of co-morbid factors showed diabetes in 225 (60.0%), hypertension in 150 (40%) patients. Radio-cephalic fistula was done in 295 patients and brachiocephalic fistula in 80 patients. In 5% dominant hand was used and for remaining 95% of the patients fistula was created on non-dominant hand. Arterio-venous fistula was successful at 6 weeks in 95%, at 2 years in 90% and at 5 years in 85% patients. In 5% cases, failure in first 6 weeks was because of primary failure or wound infections and at 2-5 years failure due to stenosis of cephalic vein by repeated punctures and thrombosis. In failed patients redo procedure was carried out successfully at another (cubital) site. Conclusion: Radio-cephalic arteriovenous fistula in patients with end stage renal disease requiring long term vascular access for haemodialysis remains the procedure of choice if done by experienced hands.
A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis
Seminars in Dialysis, 2020
Introduction: Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure. Methods: Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end-to-side variety. Parameters studied were age, gender, diabetes mellitus, hypertension prior to end-stage kidney disease (ESKD), site of fistula, blood flow rate, venous pressure, dialysis vintage and frequency, needle gauge used during dialysis, year of fistula creation, and details of fistula failure.