SAT-046 RESULTS OF THE GRACZ FISTULA CONSTRUCTED BY THE NEPHROLOGIST

Abstract

Gracz arteriovenous fistula (AVF) at the elbow involves an end to side anastomosis between the and of the perforating vein to the median cubital vein to the side of brachial artery (Fig 1). The anastomotic site is below the elbow crease. This analysis was aimed to assess fistula patency, maturation and complication rates in Gracz elbow fistulas constructed by the Nephrologist. At our Nephrology centres, all AVF surgeries are performed by the Interventional Nephrologists (SRB and SSS) independently. Case records and follow up data of all patients undergoing Gracz AVF during the study period of April 2014 to March 2016 was retrieved. AVF outcome was assessed by short term fistula patency (first 24 hrs), medium term patency (upto 3 months), fistula maturation and complications. Gracz AVF was constructed whenever operating Nephrologist observed a suitable perforating vein available for anastomosis. In rest of the patients more conventional elbow AVF (side to side median cubital vein to the brachial artery; end to side median cubital to the brachial artery; end to side cephalic vein to the brachial artery or end to side basilic vein to the brachial artery) were contructed. Short term patency rate was defined as a clinically audible bruit with colour doppler evidence of patent AVF. Medium term patency rate was defined as a clinically audible bruit with colour doppler evidence of > 600 ml/min blood flow in cephalic vein in arm. AVF was considered mature if successfully cannulated by 16 G” AVF needle with blood flow rate of >250 ml/min. Surgical steps in Gracz Fistula at elbow : The perforating vein to the brachial vein is identified and tied Brachial artery identified and arteriotomy is done After successful end of the perforating vein to the side of the artery anastomosis During the study period a total of 53 Gracz elbow AVF were constructed which accounted for 10.9 % of all AVF and 30.4 % of all elbow AVF. Of all Gracz fistulae, left elbow was the site for 77.4 % cases. 51 patients had short term patency (96.2 %). Of these, 2 patients died within 3 months period and 4 were lost to follow up. Out of 47 patients available for follow up 43 patients met medium term patency criteria (91.4%). All but 2 AVFs were successfully cannulated 3 weeks after the surgery. One patient had delayed wound healing and one patient had limb edema during the follow up period. The Gracz elbow fistula has very good success rate. Such surgeries can be performed by the Nephrologists independently