Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature

ABSTRACT

Background: This study describes our experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis. Materials and Methods: This study has been carried out in our hospital from January 2004 to December 2012. A total of 505 AVFs were created in 443 patients. Maximum follow-up was 8 years, and minimum was 6 months. Observations and Results: In this study of 505 cases of AVFs, primary patency rates by Kaplan — Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. Our primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 459 (90.9%) and thrill in 451 (89.3%) cases. During dialysis, flow rate >250 ml/min was obtained in 150 (29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema, 33 (6.5%) developed steal phenomenon. Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. Flow rates in patients with vein diam. >2 mm were significantly higher as compared with patients with vein diam. <2 mm (P < 0.001). Flow rates are higher in non-diabetic patients as compared to diabetic patients (P < 0.001). Average blood urea and serum creatinine values are significantly lesser in patients undergoing dialysis through successful fistulas as compared to patients with failed fistulas. Correspondingly, incidence of deaths is significantly lesser in patients with successful fistulas. During proximal side-to-side fistula between antecubital/basilic vein and brachial artery, dilating of the first valve toward wrist helps to develop distal veins in the forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in the arm.

KEY WORDS

Arteriovenous fistula - chronic kidney disease - haemodialysis - vascular access

 

Conflict of Interest

None declared.

• REFERENCES

• 1 Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275: 1089-92
• 2 Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW. et al. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007; 53: 766-72
• 3 III. NKF-K/DOQI clinical practice guidelines for vascular access: Update 2000. Am J Kidney Dis 2001; 37 (Suppl. 01) Suppl S137-81
• 4 Konner K. Primary vascular access in diabetic patients: An audit. Nephrol Dial Transplant 2000; 15: 1317-25
• 5 Tordoir JH, Van Der Sande FM, De Haan MW. Current topics on vascular access for hemodialysis. Minerva Urol Nefrol 2004; 56: 223-35
• 6 Young EW, Dykstra DM, Goodkin DA, Mapes DL, Wolfe RA, Held PJ. Hemodialysis vascular access preferences and outcomes in the dialysis outcomes and practice patterns study (DOPPS). Kidney Int 2002; 61: 2266-71
• 7 van Andringa de Kempenaer T, ten Have P, Oskam J. Improving quality of vascular access care for hemodialysis patients. Jt Comm J Qual Saf 2003; 29: 191-8
• 8 Kong NC, Morad Z, Suleiman AB. Subclavian catheters as temporary vascular access. Singapore Med J 1989; 30: 261-2
• 9 Roy-Chaudhury P, Kelly BS, Melhem M, Zhang J, Li J, Desai P. et al. Vascular access in hemodialysis: Issues, management, and emerging concepts. Cardiol Clin 2005; 23: 249-73
• 10 Chesser AM, Baker LR. Temporary vascular access for first dialysis is common, undesirable and usually avoidable. Clin Nephrol 1999; 51: 228-32
• 11 Weiswasser JM, Kellicut D, Arora S, Sidawy AN. Strategies of arteriovenous dialysis access. Semin Vasc Surg 2004; 17: 10-8
• 12 Malovrh M. Approach to patients with end-stage renal disease who need an arteriovenous fistula. Nephrol Dial Transplant 2003; 18 (Suppl. 05) Suppl V50-2
• 13 Haimov M, Baez A, Neff M, Slifkin R. Complications of arteriovenous fistulas for hemodialysis. Arch Surg 1975; 110: 708-12
• 14 Al Shohaib S, Al Sayyari A, Waness AA. Hemodialysis angioaccess choice and survival in a tertiary care Saudi Arabian center from 1993 to 2004. Nephrourol Mon 2011; 3: 69-73
• 15 Bakari AA, Nwankwo EA, Yahaya SJ, Mubi BM, Tahir BM. Initial five years of arterio-venous fistula creation for hemodialysis vascular access in Maiduguri, Nigeria. Internet J Cardiovasc Res 2007; 4: 1-6
• 16 Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ. et al. Hemodialysis arteriovenous fistula patency revisited: Results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008; 3: 714-9
• 17 Silva Jr MB, Hobson 2nd RW, Pappas PJ, Jamil Z, Araki CT, Goldberg MC. et al. A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27: 302-7
• 18 American College of Radiology (ACR). American Institute of Ultrasound in Medicine (AIUM), Society of Radiologists in Ultrasound (SRU). ACR-AIUM-SRU Practice Guideline for the Performance of Peripheral Arterial Ultrasound using Color and Spectral Doppler. Reston (VA): American College of Radiology (ACR). 2010; p. 5
• 19 Lok CE. Fistula first initiative: Advantages and pitfalls. Clin J Am Soc Nephrol 2007; 2: 1043-53
• 20 Kazemzadeh GH, Modaghegh MH, Ravari H, Daliri M, Hoseini L, Nateghi M. Primary patency rate of native AV fistula: Long term follow up. Int J Clin Exp Med 2012; 5: 173-8
• 21 Beathard GA. Fistula First National Vascular Access Improvement Initiative - A Practioners’s Resource Guide to Hemodialysis Arteriovenous Fistulas - ESRD Network 13, 2004. http://www.esrdnet15.org/QI/C5E.pdf [Last accessed on 2013 Jul 11]
• 22 Hossny A. Brachiobasilic arteriovenous fistula: Different surgical techniques and their effects on fistula patency and dialysis-related complications. J Vasc Surg 2003; 37: 821-6
• 23 Sultan S, Hynes N, Hamada N, Tawfick W. Patients on hemodialysis are better served by a proximal arteriovenous fistula for long-term venous access. Vasc Endovascular Surg 2012; 46: 624-34