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The steady increase in patients requiring maintenance haemodialysis warrants a logical and systematic approach to creating good vascular access (VA). With an increasing number of patients presenting at a younger age, it is imperative to provide a single VA that is reliable and long-lasting. The VA must be tailored to the individual patient, providing continuous viable access for a long duration with minimal complications. Since the appropriate dialysis access aligns with the final modality for kidney replacement therapy (dialysis or transplant), it must be individualized to help patients achieve their life goals safely. Creating an arteriovenous fistula (AVF) to provide a patent and long-term vascular access (VA) for haemodialysis (HD) still remains a challenge.
In a study among Indian patients, AV fistula creation showed 90% and 83% patency of fistulas at the end of six months and one year respectively. The primary failure rate was 8.80%. Thrombosis is the leading cause of primary failure of AVF, followed by stenosis. Balloon fistuloplasty is done in both conditions to make AVF patent again.
In a study done on fistuloplasty, it showed AVF patency was observed in 76.8% of patients in the 6th month, 73.1% of patients in the 12th month, 64.6% of patients in the 18th month, and 54% of patients in the 24th month.
Hence, restoration of the function of a dysfunctional native AVF is associated with a serious advantage for the patient. The patency rates in the 2 year follow-up of the patients undergoing a successful procedure at the first attempt in this study demonstrate that clinical success is sufficient.
In our single-centre observational study, there were 34 patients who underwent fistuloplasty. Out of them, 24/34 patients (70.6%) were male and 10/34 patients (29.4%) were female. The indications of fistuloplasty included 5/34 patients due to primary AV Fistula formation failure, 4/34 patients due to thrombosis, 3/34 patients due to stenosis, 2/34 patients due to poor flow and the rest 20/34 patients due to complex mechanisms. We followed all the patients 1 year post fistuloplasty for long term outcome. 2/34 patients had primary failure and alternative mode of vascular access was achieved. 2 out of rest 32 patients had failure at 3 months. 3 out of rest 30 patients had failure at 6 months, out of which 1 patient underwent fistuloplasty again and it was functional again. 2 of the rest 28 patients had failure at 12 months, whereas 2 patients underwent renal transplantation during the same time. Hence, a significant amount of 26/34 patients (76.4%) were continuing their HD through the vascular access which was achieved post fistuloplasty.
Salvaging the fistula is an important measure for the continuation of therapy in CKD patients. it's of paramount importance to identify the early signs of fistula failure and to take timely measures. The newest technologies and interventional techniques have given a new era for the preservation of dialysis access. In our single center tertiary care study population, fistuloplasty have given improved quality of life and outcome in Hemodialysis patients.