Introduction:
Arteriovenous fistula (AVF) is considered as gold standard access for maintenance hemodialysis and with the rising burden of CKD amongst the global population it should be imperative that nephrologist learn the art of vascular creation to meet the demands
A mature vascular access is considered as the lifeline for CKD patients on maintenance hemodialysis hence its timely creation is a necessity but beyond reach for most patient given the burden and other surgical procedure that are the priority of various surgeons.
In India vascular access is performed by most various surgeons for eg: plastic surgeon, urologist, ctvs and vascular surgeons and given the vessels sizes of the preferred vascular access and surgical techniques most surgeons hence the gap between demand and supply can be met by nephrologist.
Methods:
The study was a prospective observational single centre study amongst chronic kidney disease patient stage 4 and 5 and patient who have successfully created an av fistula, following which patient were followed up after 6 weeks. Patient less than 18 years have been excluded from the study. The study was conducted with the primary endpoint as patients who have undergone two complete hemodialysis session successfully using two cannulation needles for the complete prescribed duration.
Results:
A total of 80 patients were included in the study with mean age of patients being 55.4 ± 12.5 years and 52 patients in the study were male. The mean duration of chronic kidney disease was 4.4 ± 1.2 years .58 patients in the study had diabetes mellitus and 65 patients were hypertensive. The mean serum creatinine was 8.4 ± 2.4 mg/dl at the time of av fistula creation. The mean size of radial artery was 2.1 ± 0.4 mm and cephalic vein size with augmentation was 2.1 ± 0.6 mm of which 30 patients had pre operative distal cephalic vein size between 1.6 – 2 mm. 70 patients were cannulated successfully. 28 of the 30 patients with size less than 2 mm were successfully cannulated which was statistically significant.
Conclusions:
We found most fistula created in our centre were preemptive fistula and although the cephalic vein size was smaller than recommended, successful cannulation of these veins was possible, however further follow up and more data is required.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.