Aneesh Srivastava, Manas R. Pradhan, Jatinder Kumar, M. S. Ansari, Rakesh Kapoor, S. K. Agrawal
Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
OBJECTIVES: This study aims at evaluating the clinical presentation and surgical management of the complications associated with surgically created arterio-venous fistulas in patients on maintenance hemodialysis.
METHODS: This is a retrospective cohort study from January 2001 to December 2011. All anastomosis were end-to-side. Data regarding the age, gender, AVF site, and presentation and management of the complications was recorded and analyzed. Early thrombosis and recurrent failure were not included.
RESULTS: Total of 5,602 AVF was made in 4,446 patients. Male to female ratio was 2:1. Age ranged from 12-66 years (mean 42.3+10.68). Sites of AVF created were radio-cephalic, brachio-cephalic, brachio-basilic without transposition and brachio-basilic with transposition in 5,369, 341, 188, 5 and 40 patients respectively. Complications occurred in .01%, .13%, 0.0% and .15% respectively.
A total of 127 were operated for complications. Mean duration between AVF creation and complication was 38.8 months (range 2 days-129 months). Most common was pseudo-aneurysm in 115/127 with 9/115 at venipuncture site (presented with bleed) and 106/115 at anastomosis (only three presented with bleed), with others being venous hypertension, arterial steal syndrome, and pulmonary hypertension. Most of them occurred at radio-cephalic AVF at wrist (80/127). Surgical intervention was done in all with salvage of AVF in 13.8% patients (5/9 of pseudoaneurysm at venipuncture site). Brachial fistula complications required repair of artery while radial artery was ligated with no postoperative event (follow-up ̶ 3.5 years).
CONCLUSIONS: Pseudo-aneurysm is the commonest complication. Aggressive management of pseudo-aneurysm at venipuncture site must be done to salvage AVF.
AUTHOR DISCLOSURES: S. K. Agrawal, Nothing to disclose; M. S. Ansari, Nothing to disclose; R. Kapoor, Nothing to disclose; J. Kumar, Nothing to disclose; M. R. Pradhan, Nothing to disclose; A. Srivastava, Nothing to disclose.
Posted April 2012