Complications of Arteriovenous Fistula Created for Hemodialysis Access and Treatment Approaches

Abstract

Objectives:Patients with chronic renal failure who are treated with hemodialysis need a patent arteriovenous fistula (AVF). This study was an analysis to determine the best approach to prevent complications and provide treatment. Methods: In this retrospective study, a total of 437 AVF patients' medical records and postoperative epicrisis with 4 years of clinical follow-up were evaluated. The preferred method of anastomosis surgery was the end-to-side technique. Complications were divided into categories of early (seen within 48 hours), and late (after 48 hours). Results: Of 437 patients, 288 (65.9%) were men, and the remaining 149 (34.1%) were women. The mean age was 46 years (range: 20-72 years). The locations of fistulas were snuffbox (n=42; 8.5%), radiocephalic (n=298; 60.9%), brachiocephalic (n=126; 25.6%), and brachiobasilic (n=25; 5%). Early complications were thrombosis (n=57; 69.5%), bleeding (n=14; 17%), and hematoma (n=11; 13.4%). Late complications observed were thrombosis/stenosis (n=25; 39.6%), venous hypertension (n=4; 6.3%), aneurysmatic dilatation (n=12; 19%), infection (n=6; 9.5%), bleeding/hematoma (n=7; 11.1%), arterial steal syndrome (n=4; 6.3%), congestive heart failure (n=1; 1.5%), seroma (n=2; 3.1%), and neuropathy (n=2; 3.1%). The most frequent of 145 total complications observed during the follow-up period was thrombosis (n=82; 16.7%). Conclusion:The benefits of ultrasound assistance in both the control and treatment of bleeding was also a supportive measure for the management of complications, such as steal syndrome, as it can be used to develop the best treatment strategy by considering flow velocities, or in the case of venous hypertension, to detect central stenosis. Embelectomy with re-operation may be preferred in a case of thrombosis, rather than embelectomy alone, as it is a time-consuming procedure and was reported in our clinic to be less effective when a standalone procedure.

Arteriovenous fistula access for dialysis using vessels of the arm

“…The majority of the patients were males with 79%, while females were 21%. This demography is similar to the studies by Fitzgerald et al, 11 Shahnawaz et al, 12 Demiral et al, 13 Korepta et al, 14 and Yoo et al, 15 who all documented in their respective studies that higher percentages of men had AVF access created for haemodialysis. Similarly, the mean ages of 55, 56 and 59 years were reported by Sahasrabudhe et al, 16 Fitzgerald et al, 11 and Yoo et al, 15 respectively.…”

“…Others were seroma (4,60%), spontaneous thrombosis (4.60%), superficial wound infection (3.45%), steal syndrome (1.15%) and upper limb oedema (1.15%). Previous studies had reported complication rates of 17.7%, 16 22.22%, 21 33.18% 13 and 47% 11 respectively in their studies.…”

Early Complications of Arteriovenous Fistula in patients on maintenance Hemodialysis

“…3 another study by Demiral S et.al, DM was found in 43.2% patients and hypertension was found in 13.2% patients. 7 this difference is due to variable disease burden in different parts of the world with DM being the leading cause of ESRD in Indian subcontinenet and Hypertension in the western countries. 3 The preferred site of AVF is radiocephalic followed by brachiocephalic fistula, 7 however in patients with DM and peripheral vascular disease, brachiocephalic fistula is preferred to avoid complications related to vascular access and maintenance of fistula.…”

“…7 this difference is due to variable disease burden in different parts of the world with DM being the leading cause of ESRD in Indian subcontinenet and Hypertension in the western countries. 3 The preferred site of AVF is radiocephalic followed by brachiocephalic fistula, 7 however in patients with DM and peripheral vascular disease, brachiocephalic fistula is preferred to avoid complications related to vascular access and maintenance of fistula. 7 As most of the patients in our study were diabetic with deficiency of peripheral venous structures, brachiocephalic fistula was preferably constructed in majority of the patients (56%) to avoid its complicatins.…”

“…Thus dysfunction of fistulas is the most common reason for recurrent hospitalization and increased morbidity. 7,8 These problems are more pronounced in resource poor countries due to their poor socioeconomic status. 2 This study focuses on the knowledge of complications of AVF in our set up.…”