End Stage Renal Disease: AVF for Hemodialysys: Clinical Assessment with/without Ultrasound Doppler, Complications and Failure

Abstract

Objective/Background: The objective of this study was to study the complications and failure rate after creating an arteriovenous fistula in patients suffering from end-stage renal disease (chronic renal failure). It was also intended to study the importance of preoperative Clinical assessment/physical examination of the patient; and if the vessels for anastomosis appeared to be of a doubtful size, then a doppler study was done to ensure that the vein is of adequate size for creation of a good fistula. Method: In this study 121 cases of end-stage renal disease (chronic renal failure) who needed vascular access for hemodialysis were taken. Ultrasound Doppler study was conducted in those patients whose vessels (for anastomosis) appeared to be of small size on Clinical examination. In the study, the arteriovenous fistulae were created under local anesthesia observing all aseptic precautions. Results: Most commonly, the difficulty encountered during surgery was when the caliber of the vein was small i.e. less than 2.5 mm. An arteriovenous fistula was created only when the size of the vein was at least 2.0 mm. When the size of the vein was small, then a longitudinal incision was given in the vein or Cheatlemanouvre was undertaken to perform the anastomosis. In 4 of the 121 cases when radiocephalic fistula was attempted, we had to convert to brachio-cephalic. No major complication was encountered during the surgery or post-operatively. Some patients (five) had redness and inflammation. Inflammation and redness subsided with antibiotics and it resulted in satisfactory recovery. The fistulas started well showing good thrill. After 30 days, 106 out of 121 AV fistulas created were functioning very well with a patency rate of 87.6%. Conclusion: There was no major complication after creating an arteriovenous fistula. It is important to do a thorough physical examination before surgery so that the vessel is assessed. In doubtful cases, an ultrasound doppler study should be done to know the size and patency of the vessel. We should also take relevant history especially of hypertension, diabetes, i/v canulation, etc.