Presentation on theme: "FACTORS IN SUCCESSFUL OUTCOME IN RADIO-CEPHALIC AV FISTULA"— Presentation transcript:
1FACTORS IN SUCCESSFUL OUTCOME IN RADIO-CEPHALIC AV FISTULA Dr. Venkateshwara Rao K, Dr. Aniruddha G, Dr.M. Ismail Dr. Sanjay Swain Dr. Sujata PatwardhanDr Jayesh V DhabaliaSeth G S Medical College & K.E.M. Hospital, Mumbai
2IntroductionThe distal autogenous arteriovenous fistula is the first option for permanent access for haemodialysis , permits easy repeated access to the circulation .However the primary reported failure rate is 12% to 24%
3AIMS AND OBJECTIVESTo assess the factors influencing the outcome of the fistula likequality of arteryquality of veinpatient on dialysisDM/HTNsexType of anastamosis
4MATERIALS &METHODSRetrospective analysis of 80 cases of radio-cephalic A-V fistula we operated in the last 3 years.Age-15 to 60 yrsMale /female-3:1Left/ right-72/8
5Materials & Methods Patients clinically assessed Venous –cephalic vein at wrist and armArterial – Allen’s testHand exercises in pre and post op periodIntra op –end-side / side-side
6Materials & Methods hypertension and 14 patients diabetes mellitus. Associated co-morbidities:74 patients hadhypertension and 14 patients diabetes mellitus.Etiology-CRF/ESRD secondary to various causes.
7Materials & Methods Other factors analysed- condition of vessel wall End-side/side –side anastamosisDM/HTNwhether patient started on dialysis prior to fistula.
8RESULTS FACTORS T PATENT OCCLUDED P SEX- M 60 53 7(11.6%) NS F 20 18 2(10%)DM NO66642(3.3%)SYES1477(50%)DIALYSISNO151(6.6%)65578(12.3%)HTN -NO651(16.6%)748(10.8%)
9RESULTS FACTORS T PATENT OCCLUDED P ARTERY-G 78 71 7(8.9%) S 2 2(100%) 2(100%)VEIN G70691(1.4%)108(80%)ANAST-EE20182(10%)NSES60537(11.6%)
10RESULTS In our study predictors of poor out come were Poor quality of arteryPoor quality of veinPatient on prior dialysisPresence of diabetesSex, type of anastamosis does notseem to affect the outcome.
11RESULTS There were total of 9 failures. 5 early-within 3 months 4 late-Good fistula function initially as evidenced by thrill.3 developed thrombosis with fistula closure after 6 m.1 patient developed fistula closure following proximal vein thrombosis.
12RESULTS Of 9 patients who developed failure 8 were diabetics ,8had a narrow caliber vein,8 had hypertension.Other complicationswound infection- 3 patients.
13DISCUSSIONPatients with end-stage renal disease (ESRD) are dependent on long-term dialysis until transplantation is possible .There is consensus that the distal autogenous arteriovenous fistula is the first option for permanent access for haemodialysis (1).
14DISCUSSIONIt was found that patients whose fistula was constructed before the start of dialysis had significantly better results than patients who were already on dialysis at the time of operationThese patients were more likely to have indwelling central venous catheters as well as multiple punctures of lower arm veins during their stay in intensive care units (2,3)
15DISCUSSIONprevious studies have associated female sex (4, 5,6), and greater age(5) with poor outcome,however our study fails to show them as poor prognostic factors.
16DISCUSSIONIn our study patients with poor quality vein &artery had higher chances of failure ,more so if the patient was a diabetic.
17CONCLUSIONSThe quality of the vessels is the most important factor influencing the outcome of the fistula. If preoperative clinical evaluation of the wrist shows questionable vessel quality or caliber ,the surgeon must have a low threshold to consider a more proximal AV fistula particularly if the patient is diabetic.
18CONCLUSIONSwe should consider creating fistula at an early stage, preferably before dialysis has started.
19REFERENCES1) The Vascular Access Work Group. NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation—Dialysis Outcomes Quality Initiative. AmJ Kidney Dis 1997; 30 (suppl. 3): S150–1912)Koo Seen Lin LC, Burnapp L. Contemporary vascular access surgery for chronic haemodialysis. J R Coll Surg Edinb 1996; 41: 164–169.3) Murphy GJ, White SA, Nicholson ML. Vascular access for haemodialysis. Br J Surg 2000; 87: 1300–13154)Colledge J, Smith CJ, Emery J, Farrington K, Thompson HH. Outcome of primary radiocephalic fistula for haemodialysis. Br J Surg 1998; 86: 211–216
20REFERENCES5) Enzler MA, Rajmon T, Lachat M, Largiade`r F. Longterm function of vascular access for hemodialysis. ClinTransplant 1996; 10: 511–5156) Lazarides MK, Iatrou CE, Karanikas ID, et al. Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur JSurg 1996; 162: 297–301