Surgical Management of Failing Arteriovenous Fistula as a hemodialysis Access

Abstract

Background: Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis in patients with CKD. However, AVFs can encounter complications that lead to access failure, requiring surgical intervention. This study aimed to evaluate the effect and effort of surgical management of access failure after creation regarding to patency rate, and complication rate. Methods: This prospective study enrolled 20 patients with chronic kidney disease and AVF complications after creation. Inclusion criteria included age between 12-75 years, chronic renal failure with autogenous dialysis access, and confirmed AVF stenosis or other complications. Demographic data, comorbidities, clinical examinations, laboratory tests, imaging studies, and preoperative ultrasound assessments were collected. Detailed information on AVF specifics, surgical procedures performed, salvage interventions, patency measurements, and complications were documented. Results: The study included patients with a mean age of 55.5 ± 14.7 years, with a higher distribution in the age group of 41-60 years. Diabetes was the most prevalent comorbidity among the studied patients. Brachio-cephalic fistulas were the most common type of access, and thrombosis and infection were the primary complications observed. The primary patency rate was 2.3 ± 1.9 years, while secondary patency showed a decline over time. Complications such as hematoma, infection, and thrombosis were recorded, with varying rates of wound healing outcomes. Conclusion: Surgical management of failing AVFs in patients with chronic kidney disease can be effective in maintaining access patency. However, complications and decreasing secondary patency rates necessitate careful consideration and individualized approaches.