Analysis of Factors Affecting the Outcome of Arteriovenous Fistula Created for Hemodialysis with Small Size Veins
Abstract
ABSTRACT
Background: Increasing number of patients nowadays require hemodialysis in our country, urgent HD can be achieved by a double lumen catheter inserted into a central vein, while long term HD require permanent access through creation of an arteriovenous fistula.
Objectives: To help surgeons to get a well-functioning created arteriovenous fistula even for patients who have small size veins by improving the peri-operative conditions which may affect the outcome.
Methods: A prospective study is carried out on 42 patients with small-sized veins (3 mm in diameter) from January 2009 to December 2013 at Al-Yarmouk Teaching Hospital and private sector. These patients underwent arteriovenous fistula creation with special perioperative steps to improve the outcome of created arteriovenous fistula.
Results: After a mean follow up period of 6 months (rang from 3-18 months), 35 patients (83.3%) have got a successful functioning AVF for permanent HD, in one patient (2.35%) the arteriovenous fistula was well functioning but he develop distal hand ischemia and therefore; the arteriovenous fistula was ligated, the rest of six patients (14.35%) did not get benefit from the operation as the arteriovenous fistula fail to function satisfactorily.
Conclusion: All patients with chronic renal failure should have a chance to create a permanent AVF for them even if they have a small not sizable vein on initial examination, veins of about 3 mm in diameter can be used to create successful AVF if they are handled carefully intra-operatively together with a good peri-operative preparation and follow up.
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