Study of Factors affecting Outcomes of Arteriovenous Fistula
Bhushan P Patil, Sachin R Sarode, Umesh Shelke, Sujata Patwardhan
INTRODUCTION: There are very limited data available in the literature showing causal relationship of various factors on arteriovenous fistula (AVF) patency. This study was designed to find out the causes of AVF failure at Seth Gordhandas Sunderdas (GS) Medical College and King Edward Memorial (KEM) hospital, Mumbai. MATERIALS AND METHODS: We have done a prospective interventional study in the Department of Urology of Seth GS Medical College and KEM hospital, Mumbai, for patients of end-stage renal disease (ESRD). We enrolled 83 patients serially referred for AVF. These patients were evaluated with an interval of 1 month, for a duration of 6 months after AVF creation. RESULTS: A single surgeon performed and assisted surgery to avoid technical bias. Out of 83 patients, 7 patients were lost to follow-up, so statistical analysis was done with the remaining 76 patients. Sixty (of 76) patients developed good vein for hemodialysis (HD) access at the end of 6 months; 16 patients failed to develop the vein for HD. We found that the fistula patency rate was higher in patients with low body mass index (BMI; less than 30 kg/m2), age < 50 years, vessel diameter of more than 2.5 mm at the forearm, and in patients who were not on HD at the time of fistula creation. The fistula patency rate could not be correlated to factors like sex and diabetes. We had only 5 proximal fistulas and, hence, subgroup analysis between distal and proximal fistula was not done. We had a primary failure rate of 69% (11 patients) and a secondary failure rate of 31% (5 patients). In our study, 8 patients developed wound infection; 10 patients developed mild edema of the forearm. We had no major complications. CONCLUSION: The AVF created with smaller artery and vein has a high failure rate. Increased BMI was associated with early failure. The longevity of AVF can be increased by early AVF creation when the patient is still not on HD.
Arteriovenous fistula, End-stage renal disease, Hemodialysis, Patency