Arteriovenous fistula access for dialysis using vessels of the arm

Abstract

Background: Site selection, configuration of the access and technical performance of operation are keys to a successful arteriovenous fistula (AVF) for haemodialysis. Objective: To evaluate the primary success rate and complications of AVF performed in Port Harcourt using vessels of the arm. Materials and Methods: This was a prospective cross-sectional study on the success rate of the Arteriovenous fistulas done using vessels of the arm in patients with End Stage Renal Disease (ESRD) undergoing dialysis across public and private health facilities in Port Harcourt. The study was conducted between March 1, 2017, and February 29, 2024. Preoperatively, using a duplex scan (and sometimes through clinical examination) with and without a tourniquet, the selected vein size was ≥ 2.5mm and the artery ≥2mm with a healthy wall and good flow. Parameters monitored were thrill and bruit intra-operatively, immediate, one- week and 6-8 weeks post-operative periods; the size of the vein intra-operatively, one -week and 6-8 weeks post-operatively. In addition, the patients were monitored for complications. Data were analyzed using statistical packages for social sciences (SPSS) version 25. Th demographic data and medical information were summarized using descriptive statistics (mean, median, frequency percentage and standard deviation) as appropriate. Result: There were 87 patients during the period under review. The age range was 14-85years with mean age of 54 ± 6.4 years. Of these, 18 (20.69%) were females, and 69 (79.31%) were males; 92 AVFs were done in 87 patients (87 primary and 5 repeat) with ESRD for dialysis; 69 (75%) Brachiocephalic (BC) and 23 (25%) Brachiobasilic (BB)AVFs. The AVFs were primarily successful in 82 cases (94.25%), with 5 primary failures (5.75%), and a total of 5 repeat AVFs within this period, excluding secondary failures. Complications were 1 (1.15%) upper limb oedema, 6 (6.90%) delayed wound healing, 4 (4.60%) cases of seroma, 1 (1.15%) case of steal syndrome, 4 (4.60%) cases of spontaneous thrombosis and 3 (3.45%) cases of superficial wound infection. Conclusion: The primary success rate of AVF for dialysis in Port Harcourt using vessels of the arm is quite good with few complications.