Background: Vascular access (VA)
is the life line for end stage renal disease (ESRD). Though there are many
methods of VA, native arteriovenous fistula (AVF) is the oldest and the best.
AVFs are prone to develop some complications. The aim of this combined
prospective and retrospective clinical study was to assess the outcome of native
haemodialysis AVF in Baghdad Medical City Teaching Hospital, Baghdad, Iraq. Materials and Methods: Sixty-seven
patients (43 males and 24 females) with ESRD were studied over 6 months, from April
1 to September 30, 2013. Demographic and clinical features as well as
co-morbidities were checked. Allen’s test and examination of upper limb
superficial veins were performed. Radio-cephalic or brachio-cephalic AVFs were
created mostly under local anaesthesia using artery-side to vein-end
anastamoses. Complications were noted during a follow-up period of 2 weeks to 6
months. Results: The mean age
was 51.2 ± 14.4 years. Fistulas (n = 81) were mostly brachio-cephalic (n = 74,
91.4%). One fifth of patients were diabetics and 58.2% were hypertensive. End
of the vein to side of the artery was used in 92.5%. All fistulae functioned
primarily. Significant complications were thrombosis (n = 18, 22.2%), aneurysms
(n = 3, 4.5%) and steal syndrome (n = 3, 13.6%). Distal oedema, venous
congestion, wound infection and seroma were managed conservatively. Three
surgical revisions were required, one for a large aneurysmal dilation
(aneurysmectomy and vessel ligation) and two for an evacuation of seroma. Conclusion: AVF initial success was
good. Late complications such as aneurysms and steal syndrome were almost
within the reported rates whilst thrombosis was high.
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