Complications of Arteriovenous Fistula Created for Hemodialysis Access and Treatment Approaches
Objectives: Patients with chronic renal failure who are treated with hemodialysis need a patent arteriovenous fistula (AVF). This study was an analysis to determine the best approach to prevent complications and provide treatment.
Methods: In this retrospective study, a total of 437 AVF patients’ medical records and postoperative epicrisis with 4 years of clinical follow-up were evaluated. The preferred method of anastomosis surgery was the end-to-side technique. Complications were divided into categories of early (seen within 48 hours), and late (after 48 hours).
Results: Of 437 patients, 288 (65.9%) were men, and the remaining 149 (34.1%) were women. The mean age was 46 years (range: 20-72 years). The locations of fistulas were snuffbox (n=42; 8.5%), radiocephalic (n=298; 60.9%), brachiocephalic (n=126; 25.6%), and brachiobasilic (n=25; 5%). Early complications were thrombosis (n=57; 69.5%), bleeding (n=14; 17%), and hematoma (n=11; 13.4%). Late complications observed were thrombosis/stenosis (n=25; 39.6%), venous hypertension (n=4; 6.3%), aneurysmatic dilatation (n=12; 19%), infection (n=6; 9.5%), bleeding/hematoma (n=7; 11.1%), arterial steal syndrome (n=4; 6.3%), congestive heart failure (n=1; 1.5%), seroma (n=2; 3.1%), and neuropathy (n=2; 3.1%). The most frequent of 145 total complications observed during the follow-up period was thrombosis (n=82; 16.7%).
Conclusion: The benefits of ultrasound assistance in both the control and treatment of bleeding was also a supportive measure for the management of complications, such as steal syndrome, as it can be used to develop the best treatment strategy by considering flow velocities, or in the case of venous hypertension, to detect central stenosis. Embelectomy with re-operation may be preferred in a case of thrombosis, rather than embelectomy alone, as it is a time-consuming procedure and was reported in our clinic to be less effective when a standalone procedure.
1.Surratt RS, Picus D, Hicks ME, Darcy MD, Kleinhoffer M, Jendrisak M. The importance of preoperative evaluation of the subclavian vein in dialysis access planning. AJR Am J Roentgenol 1991;156:623–5. [CrossRef]
2. Enzler MA, Rajmon T, Lachat M, Largiadèr F. Long-term function of vascular access for hemodialysis. Clin Transplant 1996;10:511–5.
3. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48 Suppl 1:S176– 247.
4. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966;275:1089–92. [CrossRef]
5. Elwakeel H, Elalfy K. Vascular Access for Hemodialysis - How to Maintain in Clinical Practice. In: Suzuki H, editor. Hemodialysis. InTech: 2013.
6. Kherlakian GM, Roedersheimer LR, Arbaugh JJ, Newmark KJ, King LR. Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis. Am J Surg 1986;152:238–43. [CrossRef]
7. Iyem H. Early follow-up results of arteriovenous fistulae creat-ed for hemodialysis. Vasc Health Risk Manag 2011;7:321–5.
8. Hong SY, Yoon YC, Cho KH, Lee YH, Han IY, Park KT, et al. Clinical Analysis of Radiocephalic Fistula Using Side-to-side Anastomosis with Distal Cephalic Vein Ligation. Korean J Thorac Cardiovasc Surg 2013;46:439–43. [CrossRef]
9. Spergel LM, Ravani P, Roy-Chaudhury P, Asif A, Besarab A. Surgical salvage of the autogenous arteriovenous fistula (AVF). J Nephrol 2007;20:388–98.
10. Ferring M, Claridge M, Smith SA, Wilmink T. Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis: a randomized trial. Clin J Am Soc Nephrol 2010;5:2236–44. [CrossRef]
11. Mickley V. Steal syndrome—strategies to preserve vascular access and extremity. Nephrol Dial Transplant 2008;23:19–24.