alexa Abstract | A Long Term Study for Upper Limb Arterio-Venous Fistula Creation for Hemodialysis at a Tertiary Level Hospital in Eastern India

Kidney Disorders and Clinical Practices
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Research Article Open Access

Abstract

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.

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Author(s): Mohd Shahbaaz Khan and Prokash Sanki

Keywords

Arteriovenous fistula, Radio-cephalic fistula, End stage renal disease,Haemodialysis, Ambulatoryperitoneal Dialysis, Arteriovenous Fistula Dialysis, Chronic kidney disease (CKD), Clinical Dialysis, Dialysis Fistula, Dysuria Hemodiafiltration, Hemodialysis, Hemofiltration, Kidney Dialysis Diet, Kidney Dialysis Practice, Kidney Dialysis Prognosis, Kidney Dialysis Treatment, Kidney stones, enal Dialysis, Renal tubular acidosis (RTA)

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