OUTCOMES OF ARTERIO-VENOUS FISTULA AND FACTORS THAT AFFECT THE MATURATION OF THE CREATED ARTERIOVENOUS FISTULAE

Introduction:

●An arteriovenous fistula is surgically created anastomosis between an artery and a vein. 

●The rule of 6’s is widely used informal guide to determine when an AV fistula will support dialysis.

●Primary AV Fistula failure is an AVF that is never usable or fails within the first three months of its use.

●Factors that increase the risk of primary failure of an AVF are poor anatomy of vein, diameter of vessel, pre-dialysis hypotension, smoking, arteriosclerosis, DM-2 and older patients.

Methods:

Prospective Observational study

Analysis of the study was independent from the pre-operative evaluation by surgeon for the AV Fistula access creation. 

Pre-operative Assessment done by getting medical history. 

Arterial evaluation involve examination of both upper limb vessels to ensure their patency by assessing-  quality of the pulses, Allen’s test, detail evaluation through duplex ultrasonography

Venous evaluation involves assessment of the entire extent and its drainage to confirm its patency.

Vein distensibility assessed by application of tourniquet above the veins to demonstrate anatomically using duplex ultrasonography, that the vein planned for use is capable of dilating at least 40% of the resting internal diameter. 

Measurement of the internal diameter of the vein and artery is performed using ultrasonography.

Post-operative follow up- Presence of thrill and bruit, early post operative blood flow rate

After 6-8 weeks, review AVF determine diameter and blood flow rate

Till 1 year determine patency and complications (stenosis, thrombosis).

Results:

Out of 103 patients, mean age was 52.7 years, 67.96% were male, 86.41% were on hemodialysis, 89% hypertensive and 47% diabetic, 68.93% radiocephalic AV Fistula created. 

Complications such as stenosis seen in 23% cases followed by thrombosis seen in 19% case. 

14% patients developed primary failure out of which 4.85% had immediate failure (just after surgery).

Primary patency in 56.25%, assisted patency in 64.58% and secondary patency seen in 20.83%.

Analysis of Age >=60 years, DM=2, Presence of collateral veins, stenosis ,Allen’s test >=5 seconds and early post-operative flow rate showed statistical significance.

Analysis of Vein distensibility with AVF maturation was marginally significant and significant at the p-value < 0.1.

Analysis of Gender, occupation, smoking history, obesity, dialysis vintage, artery and vein diameter for AV Fistula maturation were not statistically significant.

Conclusions:

•Age >=60 years, DM=2, Presence of collateral veins, stenosis ,Allen’s test >=5 seconds and early post-operative flow rate were important predictive factors for successful maturation of AV Fistula.

•Analysis of Vein distensibility with AVF maturation were on the edge of significance and highly suggestive, significant at the p-value < 0.1. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.