FACTORS IN SUCCESSFUL FACTORS IN SUCCESSFUL OUTCOME IN RADIO-OUTCOME IN RADIO-

CEPHALIC AV FISTULACEPHALIC AV FISTULA

FACTORS IN SUCCESSFUL FACTORS IN SUCCESSFUL OUTCOME IN RADIO-OUTCOME IN RADIO-

CEPHALIC AV FISTULACEPHALIC AV FISTULADr. Venkateshwara Rao K, Dr. Aniruddha G, Dr.M. Ismail Dr. Venkateshwara Rao K, Dr. Aniruddha G, Dr.M. Ismail

Dr. Sanjay Swain Dr. Sujata Patwardhan Dr. Sanjay Swain Dr. Sujata PatwardhanDr Jayesh V DhabaliaDr Jayesh V Dhabalia

Seth G S Medical College & K.E.M. Hospital, Seth G S Medical College & K.E.M. Hospital, MumbaiMumbai

Introduction • The distal autogenous arteriovenous

fistula is the first option for permanent access for haemodialysis , permits easy repeated access to the circulation .However the primary reported failure rate is 12% to 24%

AIMS AND OBJECTIVES • To assess the factors influencing

the outcome of the fistula like quality of artery quality of vein patient on dialysis DM/HTN sex Type of anastamosis

MATERIALS &METHODS

• Retrospective analysis of 80 cases of radio-cephalic A-V fistula we operated in the last 3 years.

• Age-15 to 60 yrs• Male /female-3:1• Left/ right-72/8

Materials & Methods• Patients clinically assessed • Venous –cephalic vein at wrist and

arm• Arterial – Allen’s test• Hand exercises in pre and post op

period• Intra op –end-side / side-side

Materials & Methods• Associated co-morbidities:74 patients

had hypertension and 14 patients diabetes

mellitus.

• Etiology-CRF/ESRD secondary to various causes.

Materials & Methods• Other factors analysed- condition of vessel wall End-side/side –side anastamosis DM/HTN whether patient started on dialysis

prior to fistula.

RESULTS

•

FACTORS T PATENT

OCCLUDED

P

SEX- M 60 53 7(11.6%) NS

F 20 18 2(10%)

DM - NO 66 64 2(3.3%) S

YES 14 7 7(50%)

DIALYSIS NO

15 14 1(6.6%) S

YES 65 57 8(12.3%)

HTN -NO 6 5 1(16.6%) NS

YES 74 66 8(10.8%)

RESULTSFACTORS T PATENT OCCLUDE

DP

ARTERY-G 78 71 7(8.9%) S

P 2 0 2(100%)

VEIN- G 70 69 1(1.4%) S

P 10 2 8(80%)

ANAST-EE 20 18 2(10%) NS

ES 60 53 7(11.6%)

RESULTS• In our study predictors of poor out

come were• Poor quality of artery• Poor quality of vein• Patient on prior dialysis• Presence of diabetesSex, type of anastamosis does not seem to affect the outcome.

RESULTS• There were total of 9 failures.• 5 early-within 3 months• 4 late-Good fistula function initially as

evidenced by thrill.3 developed thrombosis with fistula closure after 6 m.

1 patient developed fistula closure following proximal vein thrombosis.

RESULTS• Of 9 patients who developed failure• 8 were diabetics ,8had a narrow

caliber vein,8 had hypertension.• Other complications wound infection- 3 patients.

DISCUSSION• Patients with end-stage renal

disease (ESRD) are dependent on long-term dialysis until transplantation is possible .

• There is consensus that the distal autogenous arteriovenous fistula is the first option for permanent access for haemodialysis (1).

DISCUSSION• It was found that patients whose fistula was

constructed before the start of dialysis had significantly better results than patients who were already on dialysis at the time of operation

• These patients were more likely to have indwelling central venous catheters as well as multiple punctures of lower arm veins during their stay in intensive care units (2,3)

DISCUSSION• previous studies have associated

female sex (4, 5,6), and greater age(5) with poor outcome,however our study fails to show them as poor prognostic factors.

DISCUSSION• In our study patients with poor

quality vein &artery had higher chances of failure ,more so if the patient was a diabetic.

CONCLUSIONS• The quality of the vessels is the most

important factor influencing the outcome of the fistula. If preoperative clinical evaluation of the wrist shows questionable vessel quality or caliber ,the surgeon must have a low threshold to consider a more proximal AV fistula particularly if the patient is diabetic.

CONCLUSIONS• we should consider creating

fistula at an early stage, preferably before dialysis has started.

REFERENCES• 1) The Vascular Access Work Group. NKF-DOQI clinical

practice guidelines for vascular access. National Kidney Foundation—Dialysis Outcomes Quality Initiative. AmJ Kidney Dis 1997; 30 (suppl. 3): S150–191

• 2)Koo Seen Lin LC, Burnapp L. Contemporary vascular access surgery for chronic haemodialysis. J R Coll Surg

Edinb 1996; 41: 164–169.• 3) Murphy GJ, White SA, Nicholson ML. Vascular access for

haemodialysis. Br J Surg 2000; 87: 1300–1315 • 4)Colledge J, Smith CJ, Emery J, Farrington K, Thompson HH.

Outcome of primary radiocephalic fistula for haemodialysis. Br J Surg 1998; 86: 211–216

REFERENCES• 5) Enzler MA, Rajmon T, Lachat M, Largiade`r F. Longterm

function of vascular access for hemodialysis. Clin Transplant 1996; 10: 511–515• 6) Lazarides MK, Iatrou CE, Karanikas ID, et al. Factors

affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur J

Surg 1996; 162: 297–301

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