1. FACTORS IN SUCCESSFUL OUTCOME IN RADIO-CEPHALIC AV FISTULA
Dr. Venkateshwara Rao K, Dr. Aniruddha G, Dr.M. Ismail Dr. Sanjay Swain Dr. Sujata Patwardhan
Dr Jayesh V Dhabalia
Seth G S Medical College & K.E.M. Hospital, Mumbai

2. Introduction
The 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%

3. AIMS AND OBJECTIVES
To assess the factors influencing the outcome of the fistula like
quality of artery
quality of vein
patient on dialysis
DM/HTN
sex
Type of anastamosis

4. MATERIALS &METHODS
Retrospective analysis of 80 cases of radio-cephalic A-V fistula we operated in the last 3 years.
Age-15 to 60 yrs
Male /female-3:1
Left/ right-72/8

5. Materials & Methods Patients clinically assessed
Venous –cephalic vein at wrist and arm
Arterial – Allen’s test
Hand exercises in pre and post op period
Intra op –end-side / side-side

6. Materials & Methods hypertension and 14 patients diabetes mellitus.
Associated co-morbidities:74 patients had
hypertension and 14 patients diabetes mellitus.
Etiology-CRF/ESRD secondary to various causes.

7. Materials & Methods Other factors analysed- condition of vessel wall
End-side/side –side anastamosis
DM/HTN
whether patient started on dialysis prior to fistula.

8. RESULTS FACTORS T PATENT OCCLUDED P SEX- M 60 53 7(11.6%) NS F 20 18
2(10%)
DM NO 66 64
2(3.3%) S
YES 14 7
7(50%)
DIALYSIS NO 15
1(6.6%) 65 57
8(12.3%)
HTN -NO 6 5
1(16.6%) 74
8(10.8%)

9. RESULTS FACTORS T PATENT OCCLUDED P ARTERY-G 78 71 7(8.9%) S 2 2(100%)
2(100%)
VEIN G 70 69
1(1.4%) 10
8(80%)
ANAST-EE 20 18
2(10%) NS ES 60 53
7(11.6%)

10. RESULTS In our study predictors of poor out come were
Poor quality of artery
Poor quality of vein
Patient on prior dialysis
Presence of diabetes
Sex, type of anastamosis does not
seem to affect the outcome.

11. RESULTS 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.

12. RESULTS Of 9 patients who developed failure
8 were diabetics ,8had a narrow caliber vein,8 had hypertension.
Other complications
wound infection- 3 patients.

13. DISCUSSION
Patients 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).

14. DISCUSSION
It 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 operation
These 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)

15. DISCUSSION
previous 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.

16. DISCUSSION
In our study patients with poor quality vein &artery had higher chances of failure ,more so if the patient was a diabetic.

17. CONCLUSIONS
The 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.

18. CONCLUSIONS
we should consider creating fistula at an early stage, preferably before dialysis has started.

19. REFERENCES
1) 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): S150–191
2)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: 1300–1315
4)Colledge J, Smith CJ, Emery J, Farrington K, Thompson HH. Outcome of primary radiocephalic fistula for haemodialysis. Br J Surg 1998; 86: 211–216

20. REFERENCES
5) Enzler MA, Rajmon T, Lachat M, Largiade`r F. Longterm function of vascular access for hemodialysis. Clin
Transplant 1996; 10: 511–515
6) Lazarides MK, Iatrou CE, Karanikas ID, et al. Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur J
Surg 1996; 162: 297–301

21. THANK YOU