A PROSPECTIVE STUDY OF ARTERIOVENOUS FISTULA CREATION IN PATIENTS WITH CHRONIC RENAL FAILURE IN INDEX MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE, INDORE (M.P)

Abstract

Background: Arteriovenous (AV) stulas are naturally occurring connections between an artery and a vein that enable for adequate blood ow during hemodialysis in patients with chronic renal failure. Compared to grafts, they have higher rates of patency and fewer complications. In order to achieve hyperdynamic circulation and ensure that regular venous access is not an issue, AV stula are created at various levels. The presents study sought to determine factors inuencing the patency rate of AV stulas, postoperative complications, and the success rate of AV stulas. Materials and Methods: After approval from the IEC, this prospective study was conducted in Department of General Surgery of Index Medical College Hospital & Research Centre, Indore on 100 patients of all age groups and both gender who visited the OPD with diagnosis of chronic kidney disease. A written pre-informed consent was taken from all patients before enrollment. Result: Out the 100 patients enrolled in the study, majority i.e., 63% revealed radiocephalic stulas while 12% had brachiocubital stulas. 80% of patients were treated by doing side-to-side anastomosis, while in rest 20% patients, end-to-side anastomosis was done. The AV stula remained patent in 65 (65%) patients, and among them, the patency rate of radiocephalic was 60% and that of brachiocephalic was 13.8%. The patency rate for side-to-side stula was 83.1% and that for end-to-side was 16.9%. Patency rate for patients with hemoglobin (Hb) > 9 g % was 93.85% with only 6.15% for patients with Hb < 9 g %. Nonsmokers were 3.5 times (95% CI: 1.58–8.23) more likely to have patent stula than smokers. Arterial diameter is also a predictor of patency. Conclusion: The success rate of AV stula by conventional vascular anastomosis technique was 65%. Side-to-side anastomosis showed higher patency rate than end-to-side anastomosis. Radiocephalic AV stula had better patency rate than other types of stulas performed in upper limb. Anemia (Hb < 9 g %), smoking, and arterial diameter were the major factors inuencing patency of stula. Thrombosis, surgical site infection, postoperative edema, aneurysm and steal phenomenon were the complications noticed in the postoperative period