Arterio-Venous Fistula Creation for Hemodialysis. What Is Happening in Bulgaria?

Abstract

Purpose. The arterio-venous anastomosis (AVA) continues to be the "gold standard" for vascular access in patients undergoing haemodialysis. This retrospective study aims to analyze the causes that led to End Stage Renal Disease (ESRD), the type of native AVA, their localization, and their patency. Material and Methods. The study included the last 100 consecutive and random AVAs constructed in our clinic. 68 men of average age 62.3 (+/-10.8) years and 32 women of average age 59.9 (+/-15.8) years were operated. The main causes that led to ESRD were: Glomerulonephritis - 33%, Hypertension- 24% and Diabetes- 20%. The overweight patients were 33% and the smokers - 30%. Results. AVA has been successfully constructed in 82% of the patients on the left hand and in 18% on the right hand. A distal latero-terminal radio-cephalic fistula (DLTRC) was constructed on only 8% of the patients. The most common type of anastomosis was an L.T. radio-cephalic in the forearm - 58%, followed by an L.T. brachio-cephalic fistula - 19% and latero-lateral, radio-cephalic in the forearm - 14% of the patients. The early fistula patency was - 80%, one-year cumulative patency was 94%. Conclusion. The analysis of our results shows that the relative share of the overweight and diabetes population is increasing today. In practice, solutions for the construction of primary forearm anastomosis are increasingly common.