LONG-TERM PATENCY RATE OF AV-FISTULA IN RELATION TO DIAMETER OF ARTERIOTOMY 3 MM VS <3 MM

Abstract

BACKGROUND People who develop end stage renal disease often need dialysis in which a machine performs a basic function of kidney. 1,2 Before a patient begins dialysis treatment, a minor surgical procedure called arteriovenous (AV) fistula is done. Creating an AV fistula allows arterial pressure to enlarge the vein over time better enabling it to receive the volume of blood coming back into the body. The rising prevalence of end stage renal disease (ESRD) and the consequent impact on heathcare economics has resulted in increasing focus on delivery of vascular access care which is considered the Achilles' heel of haemodialysis. The autologous arteriovenous fistula is the acceptable gold standard mode of vascular access for haemodialysis in terms of longevity, patient morbidity and health care costs in developing country like India. Brescia-Cimino Radio Cephalic Arterio-Venous fistula (RC-AVF) at the wrist remains the vascular access of choice for haemodialysis even today 3. Creating an autologous fistula with arteriotomy diameter of 3 mm in longitudinal axis of radial artery gives better success rate and long duration of patent functioning fistula. MATERIALS AND METHODS Hundred patients with ESRD were selected for whom arteriovenous fistula, radio cephalic end to side anastomosis was done. A study was done regarding the long-term patency rate by taking arteriotomy diameter into consideration. In 50 of them, 3 mm arteriotomy was done-group 1; and in another 50 of them <3 mm arteriotomy was done-group 2 patients. Two groups were compared with study variables by mean duration of surgery, intra operative bleeding, obtaining immediate thrill, visibility of immediate pulse and post operative follow up for noting the patency and functioning fistula was done every 1, 3 and 6 months. RESULTS The study results were analysed statistically by means of Mean, Standard deviation, Chi-square test and Fishers exact test for significance. Of the 100 patients, most of them were males with ESRD (74%), mean age of all patients in this study was 49.5+10.9 years., the mean duration of surgery in group was 149.3 min with p value 0.0001. Less intra operative complications were seen in group 1 patients. (p value 0.0001). Immediate pulse was seen in all 50 patients of group 1 on operation table itself. Immediate thrill was observed in 98% in group 1 and 78% of group 2 patients (p value 0.0001). All the patients were followed post operatively every 1, 3 and 6 months during their visit to nephrologist and haemodialysis centre and postoperative functioning of fistula and fistula use in dialysis enquired; observation of the patency of fistula and thrill was done. In the follow up period, patency rate after 6 months was seen in more cases of group 1 (p value 0.00001). CONCLUSION End stage renal disease patients who need a long-life vascular access for haemodialysis, arteriovenous fistula which were created at the distal forearm with end to side radiocephalic anastomosis proved to have long life of more than 6 months with 3 mm arteriotomy diameter...