DOI: http://dx.doi.org/10.18203/2349-2902.isj20202843

Our experience of arteriovenous fistula creation as vascular access for hemodialysis

Pradeep K. Sharma, Rupesh Nagori, Shekhar Baweja, Vikas Aggarwal, Pawan Katti, M. K. Chabbra

Abstract


Background: End stage renal disease (ESRD) patients depend on lifelong renal replacement therapy. The arteriovenous fistula (AVF) is the preferred hemodialysis access. Cimino fistulas are currently accepted as the best mode of vascular access for hemodialysis (HD). The present study was planned to study for presence of on table bruit and thrill and to know postoperative outcome and patency.

Methods: This single center, prospective study was carried out in department of Urology at SNMC, Jodhpur from November 2018 to May 2019.  Dominance of hand was examined, and preference was given to non-dominant hand. Physical examination of the arterial system along with physical examination of the venous system was done.  Preoperative color Doppler of upper limb veins and arteries was done in selected patients. End to side anastomosis was done between cephalic vein and radial artery.

Results: In this study of 70 cases of AVFs, there were 53 (75.71%) successful cases and 17 (24.2%) were failures.  End (vein) to side (artery) anastomosis was done in 70 (100%) cases.  On table bruit was present in 63 (90%) and thrill in 58 (82.8%) cases. All patients with failed post-operative fistula were not doing ball exercise.

Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. Post-operative ball exercise should be done for better results.


Keywords


Arteriovenous fistula, End stage renal disease, Hemodialysis

Full Text:

PDF

References


US Renal Data System USRDS 2016 Annual data report: epidemiology of kidney disease in the United States. National Institutes of Health: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; 2016:261.

Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966;275:1089-92.

National Kidney Foundation 2006. Updates to clinical practice guidelines and recommendations: vascular access. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI); 2006:244-50.

Santoro D, Benedetto F, Mondello P, Pipito N, Barilla D, Spinelli F, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 2014;7:281-94.

Vassalotti JA, Jennings WC, Beathard GA, Neumann M, Caponi S, Fox CH, et al. Fistula first breakthrough initiative: targeting catheter last in fistula first. Semin Dial. 2012;25:303-10.

Allon M. Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 2002;62:1109-24.

Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA. 2008;299:2164-71.

Oliver MJ, Rothwell DM, Fung K, Hux JE, Lok CE. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol. 2004;15:1936-42.

Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: A propensity score analysis. J Am Soc Nephrol. 2004;15:477-86.

Xue JL, Dahl D, Ebben JP, Collins AJ. The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis. 2003;42:1013-9.

Collins AJ, Foley RN, Herzog CA, Chavers BM, Gibertson D, Ishani A, et al. Excerpts from the US Renal Data System 2009 Annual Data Report: Costs of ESRD. Am J Kidney Dis. 2010;55:S1-420.

Lacson E, Jr, Lazarus JM, Himmelfarb J, Ikizler TA, Hakim RM. Balancing fistula first with catheters last. Am J Kidney Dis. 2007;50:379-95.

Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ. Hemodialysis arteriovenous fistula patency revisited: Results of a prospective, multicenter initiative. Clin J Am Soc Nephrol. 2008;3:714-9.

Maya ID, Allon M. Outcomes of tunnelled femoral hemodialysis catheters: Comparison with internal jugular vein catheters. Kidney Int. 2005;68:2886-9.

Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: A systematic review. J Vasc Surg. 2003;38:1005-11.

Alwakeel JS, Alsuwaida A, Askar A, Memon N, Usama S, Alghonaim M, et al. Outcome and complications in peritoneal dialysis patients: A five-year single center experience. Saudi J Kidney Dis Transpl. 2011;22:245-51.

Tordoir JH. Current topic on vascular access for hemodialysis. Minerva Urol Nefrol. 2004;56:223-35.

de Kempenaer TV, ten Have P, Oskam J. Improving quality of vascular access care for hemodialysis patients. Joint Commiss J Qual Saf. 2003;29(4):191-8.

Kong NC, Morad Z, Suleiman AB. Subclavian catheters as temporary vascular access. Singapore Med J. 1989;30:261-2.

Roy-Chaudhury P, Kelly BS, Melhem M, Zhang J, Li J, Desai P, et al. Vascular access in hemodialysis: Issues, management, and emerging concepts. Cardiol Clin. 2005;23:249-73.

Malovrh M. Approach to patients with end-stage renal disease who need an arteriovenous fistula. Nephrol Dial Transplant. 2003;18(5):v50-2.

Haimov M, Baez A, Neff M, Slifkin R. Complications of arteriovenous fistulas for hemodialysis. Arch Surg. 1975;110:708.

Al Shohaib S, Al Sayyari A, Abdelkarin Waness A. Hemodialysis angioaccess choice and survival in a tertiary care Saudi Arabian center from 1993 to 2004. Nephro-Urol Monthly. 2011;3:69-73.

Bakari AA, Nwankwo EA, Yahaya SJ, Mubi BM, Tahir BM. Initial five years of arterio-venous fistula creation for hemodialysis vascular access in Maiduguri, Nigeria. Internet J Cardiovasc Res. 2007;4:1-6.

Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ. CIMINO study group. Hemodialysis arteriovenous fistula patency revisited: Results of a prospective, multicenter initiative. Clin J Am Soc Nephrol. 2008;3:714-9.