A prospective study of arteriovenous fistula creation in chronic renal failure patients in Bhavnagar, Gujarat, western India

Abstract

Background: Arteriovenous (AV) fistula is an autogenous connection between an artery and a vein, which allows adequate blood flow during hemodialysis in patients with chronic renal failure, and they have superior patency rates and lower complication rates than grafts. Objective: To study the success rate of AV fistula, postoperative complications, and factors affecting the patency rate of AV fistula. Materials and Methods: This prospective study was conducted in Department of General Surgery of Sir Takhtsinhji Hospital, Bhavnagar, Gujarat, India, during 2012–2014 in patients of all age groups and both gender with chronic kidney disease. Result: Of the 150 patients enrolled in the study, 62% revealed radiocephalic fistulas while 17% brachiocubital fistulas. In majority of the patients (81%), side-to-side anastomosis was done, while in 19% patients, end-to-side anastomosis was done. The AV fistula remained patent in 115 (77%) patients, and among them, the patency rate of radiocephalic was 60% and that of brachiocephalic was 13%. The patency rate for side-to-side fistula was 83% and that for end-to-side was 18%. Patency rate for patients with hemoglobin (Hb) > 9 g % was 94% with only 6% for patients with Hb < 9 g %. Nonsmokers were 3.6 times (95% CI: 1.58–8.23) more likely to have their fistula patent than smokers. Arterial diameter is also a predictor of patency. Conclusion: The success rate of AV fistula by conventional vascular anastomosis technique was 77%. Side-to-side anastomosis showed better patency rate than end-to-side anastomosis. Radiocephalic AV fistula showed better patency rate than other types of fistulas performed in upper limb. Anemia (Hb < 9 g %), smoking, and arterial diameter were the major factors affecting fistula patency. Thrombosis, postoperative edema, surgical site infection, steal phenomenon, and aneurysm were the complications noted in the postoperative period.