A Long Term Study for Upper Limb Arterio-Venous Fistula Creation for Hemodialysis at a Tertiary Level Hospital in Eastern India
|Mohd Shahbaaz Khan1* and Prokash Sanki2|
|1Department of Cardiac surgery, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia|
|2Asst. Prof, Department of Cardiothoracic and vascular surgery, SSKM Hospital, Institute of Postgraduate Medical Education and Research, 242 AJC Bose Road, Kolkata, India|
|*Corresponding Author :||Mohd. Shahbaaz Khan
Department of Cardiac surgery, King Fahad Medical City Riyadh
Kingdom of Saudi Arabia, Saudi Arabia
Tel: +966 11 288 9999
E-mail: [email protected]
|Received date: December 30, 2015, Accepted date: April 6, 2016, Published date: April 11, 2016|
|Citation: Khan MS, Sanki P (2016) A Long Term Study for Upper Limb Arterio-Venous Fistula Creation for Hemodialysis at a Tertiary Level Hospital in Eastern India. Kidney Disord Clin Pract 1:106. doi:10.4172/kdc-1000106|
|Copyright: © 2016 Khan MS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Background: There is gradual increase in need for hemodialysis, as there is gradual increase in the end stage renal disease in India. Permanent vascular access in the patient with end stage renal disease on hemodialysis is provided through a central venous catheter, arteriovenous graft, or arteriovenous fistula. The aim of this study was to evaluate the site, results and postoperative complications of arteriovenous fistula creation in our hospital.
Method: It was a retrograde study conducted at Seth Sukhlal Karnani Memorial (SSKM) hospital, Institute of Post- Graduate Medical Education and Research (IPGMER), Kolkata, between 1st July 2006 and 30th August 2011. All patients, with end stage renal disease requiring long term vascular access for haemodialysis, were included in the study. In most of the patients radio-cephalic fistulae were created in the left forearm, in some on right forearm, just above the wrist joint, and in some patients brachiocephalic or brachiobasilic arteriovenous fistulae were created.
Results: 375 patients were studied; 292 (77.86%) males and 83 (22.14%) females, with male to female ratio of 3.52:1. Distribution of co-morbid factors showed diabetes in 225 (60.0%), hypertension in 150 (40%) patients. Radiocephalic fistula was done in 295 patients and brachiocephalic fistula in 80 patients. In 5% dominant hand was used and for remaining 95% of the patients fistula was created on non-dominant hand. Arterio-venous fistula was successful at 6 weeks in 95%, at 2 years in 90% and at 5 years in 85% patients. In 5% cases, failure in first 6 weeks was because of primary failure or wound infections and at 2-5 years failure due to stenosis of cephalic vein by repeated punctures and thrombosis. In failed patients re-do procedure was carried out successfully at another (cubital) site.
Conclusion: Radio-cephalic arteriovenous fistula in patients with end stage renal disease requiring long term vascular access for haemodialysis remains the procedure of choice if done by experienced hands.