IJCM  Vol.5 No.1 , January 2014
Outcome of Haemodialysis Arteriovenous Fistula in Baghdad, Iraq
ABSTRACT

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.


Cite this paper
A. Taha, O. Diab and S. Jaber, "Outcome of Haemodialysis Arteriovenous Fistula in Baghdad, Iraq," International Journal of Clinical Medicine, Vol. 5 No. 1, 2014, pp. 12-17. doi: 10.4236/ijcm.2014.51003.
References
[1]   A. A. Hassanien, F. Al-Shaikh, E. P. Vamos, G. Yadegarfar and A. Majeed, “Epidemiology of End-Stage Renal Disease in the Countries of the Gulf Cooperation Council: A Systematic Review,” JRSM Short Reports, Vol. 3, No. 6, 2012, p. 38. http://shr.sagepub.com/content/3/6/38
http://dx.doi.org/10.1258/shorts.2012.011150


[2]   K. Pantelias and E. Grapsa, “Vascular Access for Haemodialysis,” In: M. G. Penido, Ed., Technical Problems in Patients on Haemodialysis, InTech, 2011.
http://www.intechopen.com/books/technical-problems-in-patients-on-hemodialysis/vascular-access-for-hemodialysis

[3]   D. M. Hentschel, “Vascular Access for Hemodialysis,” Nephrology Rounds, Vol. 6, No. 1, 2008, pp. 304-305.

[4]   “CANNT Journal: The Culture of Vascular Access Cannulation among Nurses in a Chronic Haemodialysis Unit (Report) (monograph online),” Canadian Association of Nephrology Nurses & Technologists, London, 2010.
http://vodoojester.blogspot.com/2012/03/culture-of-vascular-access-cannulation.html

[5]   A. S. Y. Taha, “Provision of Vascular Access for Chronic Uremic Patients by Subcutaneous Arterio-Venous Fistula in the Upper Extremity,” Basra Journal of Surgery, Vol. 6, No. 1, 2000, pp. 28-31.

[6]   V. Mickley, “Stenosis and Thrombosis in Haemodialysis Fistulae and Grafts: The Surgeon’s Point of View,” Nephrology Dialysis Transplantation, Vol. 19, No. 2, 2004, pp. 309-311. http://dx.doi.org/10.1093/ndt/gfg504

[7]   C. T Sofocleous, J. Cerveira and S. G. Cooper, “Dialysis Fistulas,” Kyung J Cho (Chief Editor), 2013.
http://emedicine.medscape.com/article/419393-overview

[8]   J. Malik, V. Tuka, Z. Kasalova, E. Chytilova, M. Slavikova, P. Clagett, et al., “Understanding the Dialysis Access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies,” The Journal of Vascular Access, Vol. 9, No. 3, 2008, pp. 155- 166.

[9]   V. Mickley, “Steal Syndrome—Strategies to Preserve Vascular Access and Extremity,” Nephrology Dialysis Transplantation, Vol. 23, No. 1, 2008, pp. 19-24.
http://dx.doi.org/10.1093/ndt/gfm673

[10]   H.-Y. Lo and S.-G. Tan, “Arteriovenous Fistula Aneurysm—Plicate, Not Ligate,” Annals of the Academy of Medicine, Singapore, Vol. 36, No. 10, 2007, pp. 851-853.

[11]   C. S. P. Valentine and O. Aworanti, “Surgical Management of Aneurysms of Arteriovenous Fistulae in Hemodialysis Patients: A Case Series,” Open Access Surgery, Vol. 3, 2010, pp. 9-12.

 
 
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