Management of Complications of Arteriovenous Grafts in Patients with Chronic Renal Failure

Abstract

Background: With increasing number of patients sustained on chronic Haemodialysis, access related surgery forms a significant proportion of vascular surgical practice today. A cursory review of patients with Arteriovenous graft access reveals a considerable variety in short and long-term complications that could happen and in the management of those complications. Aim: The aim of this work is to assess the outcomes of different modalities of management of complications of Arteriovenous grafts in chronic renal failure patient on regular hemodialysis from arteriovenous graft. Patients and Methods: Thirty chronic renal failure patients with complicated Arterio-venous grafts performed before for regular hemodialysis were enrolled into this study. The patients were recruited from the Vascular Surgery outpatient clinic of El-Hussein University Hospital. Patients were followed up at intervals of: immediately after fistula creation, first day after creation, 1 month, 3 months, 6 months and 9 months after creation for detecting any complications. Follow up of all patients was based on clinical examination and also by duplex ultrasound and CT venography if needed. Results: Arteriovenous graft complications incidence were higher in male than females, those results were explained by male cases being associated with more co-morbidities and smoking. Venous outflow stenosis and venous hypertension were the most encountered complication, while surgical management in form of ligation and excision was the commonest management modality used. We also noticed a correlation between the duration from creation of AV synthetic graft and interval between primary and secondary intervention. The older the AV graft the longer was the interval between primary and secondary intervention. This can be correlated to years of education those group of patients had, as those patients tended to pay more attention to early manifestations and used better dialysis centers. Conclusion: Surgical management in form of graft ligation and excision or surgical revision seems to be the simplest yet most effective management modality facing the majority of the complications not neglecting the role of endovascular intervention in venous hypertension.