Abstract
Objective: To evaluate the two year patency rate of functioning arteriovenous fistula. Methodology: This prospective case series study was conducted at Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from 1st January 2009 to 31st December, 2010. Patients were chosen for CBRC arteriovenous fistula at wrist and patients undergoing other types of vascular access or secondary fistula formation were excluded. Results:One hundred and eighty two patients underwent arteriovenous fistula formation. The mean ± SD age was 63 ± 13 years and there were 102 (56%) males and 80 (44%) females. 12.6% fistulae failed within first month without dialysis. The primary patency rate was 66.5% at three months and 57.7% at six months. Failing arteriovenous fistula was managed by new arteriovenous fistula in our series. 28.6% patients had redo arteriovenous fistula. This study demonstrated a poor outcome for fistulas in diabetic patients. Fifteen out of 23 (65.2%) who failed primarily were diabetics and out of these diabetics 13 (86.7%) failed in first three months. Infection and burst fistulae were found in nine (4.9%), pseudo aneurysm in 3.2%, fever 4.9%, peri-operative failure 0.55% and burst fistulae 3.2%. Conclusions: One-third of radiocephalic fistulas fail within two years. The outcome is worse for women and diabetic patients. This information may be useful in assessing and counseling patients with end-stage renal failure. Arteriovenous fistula is the better and ideal choice for haemodialysis. A Radiocephalic fistula in forearm seems to have better results as comparison to cubital fossa arteriovenous fistula. End to side anastomosis results are better than side to side anastomosis.
Highlights
Arteriovenous fistula is the treatment of choice for hemodialysis in chronic renal failure patients
Radiocephalic arteriovenous fistulae were 114, 10 had Radial artery with Median antebrachial vein, 02 had Radial artery with venacomitant and 55 were Antecubital arteriovenous fistula made by anastomosis between Brachiocephalic, Basalic, Median cubital and 1 anastomosis were brachial artery with venacomitant (Table-I)
Arteriovenous fistula is a difficult procedure for urologists because it involves vascular surgery as well as for patients because it is painful and cumbersome, yet the urologists have to take up the task for chronic renal failure patients.[12]
Summary
Arteriovenous fistula is the treatment of choice for hemodialysis in chronic renal failure patients. Back in early 20th century the arteriovenous shunting was started for hemodialysis.[1] In 1950’s, the standard Quinton-Scribner silastic Teflon shunt infection and thrombosis were the main complications of arteriovenous shunts. Spontaneous dislocation was a major issue.[1] To overcome this problem Brescia, Cimino, and Hurlwith made surgically created fistulae between cephalic vein and radial artery at the wrist. Such type of vascular access for hemodialysis was first described in the 1966.2
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
