Arterio-venous Fistula for Dialysis- Procedure, Complications and Outcome
Keywords:AV Fistula, Vascular access for dialysis, Radio-cephalic AV Fistula, Brachio-cephalic AV Fistula
Background- In India, a 2018 estimate put the number of patients on chronic dialysis at about 175,000,
giving a prevalence of 129 per million population. About two thirds of all patients with kidney failure
die without receiving dialysis every year. For the other third, the majority (64.2%) undergo renal
replacement therapy via hemodialysis. AV fistulas are the preferred method for vascular access for
hemodialysis. This study describes the outcome of 634 AV fistulas created in our institute between
January 2015 and December 2020.
Methods- 634 patients who underwent AV fistula creation in 5 years were retrospectively studied.
Evaluation criteria were patency of AV Fistula at 1 week, 1 month, 6 months, 1 year and 2 years after
creation; suturing technique- continuous versus interrupted, 6-0 versus 8-0 suture; end-to-side versus
side-to-side anastomosis, mean operating time; duration of hospital stay; and complications- minor
bleeding episodes, major bleeding requiring intervention, serous discharge, hyperaemia, upper limb
swelling, aneurysm of anastomosis and recipient vein, delayed rupture.
Conclusions- Patency rate of AV Fistula at 1 week was 91.2%, at 1 month was 84.6%, at 6 months was
83.8% and at 1 year was 82.9%, after creation. After 2 years 74.8% AVF’s were still useful for dialysis.
Factors affecting patency were location of anastomosis, low-dose Aspirin and regular dialysis
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