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Patients with end-stage renal disease (ESRD) who require maintenance hemodialysis need dependable vascular access that can be sustained long-term. Creating an arteriovenous fistula (AVF) is the gold standard for effective blood purification. However, the quality and outcomes of AVF surgery in resource-limited settings have yet to be studied well. This study investigated the effectiveness and risk factors associated with AVF surgery success and outcomes in Vietnamese patients with ESRD.
We conducted a prospective cohort study of adult patients (≥18 years) with ESRD who underwent AVF surgery at Nguyen Tri Phuong Hospital, a tertiary center in southern Vietnam, from January 2020 to June 2020. We collected data on patients’ demographics, medical history, AVF technique, and outcomes using a structured case report form and followed them for six weeks after surgery. All AVF procedures were performed by the same surgeons using the radial artery-cephalic vein anastomosis method.
This study included 52 patients with a mean age of 58.2±1.7 years, of whom 21 (40.4%) were males and 31 (59.6%) were females. Before this episode, 30.8% (16/52) patients had undergone at least one fistula operation, and three out of them (18.8%) had experienced at least two times fistula creation procedures. The most common comorbidities were hypertension (98.1%), dyslipidemia (67.3%), and diabetes (59.6%). Most patients (73.1%) received a new fistula surgery on their wrists. The primary outcomes within 24 hours of AVF surgery were 49 (94.2%) patients with good palpable thrill, three (5.8%) developed early postoperative infection, and 11 (21.2%) experienced other complications, including bleeding. At the six-week follow-up, the successful outcomes included 26 (50.0%) patients who used their AVF successfully for hemodialysis and six (11.5%) individuals who had a weak fistula thrill with a supporting internal regimen, while the failure rate accounted for 15.4% (eight cases). There were three (5.8%) patients died before maturation (<6 weeks).
The short-term outcomes of AVF creation were favorable, but the success rate declined after six weeks. To ensure adequate time for fistula maturation and to increase the likelihood of successful hemodialysis, early preparation of the fistula is essential.