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A.Zenelaj, V.Zenelaj, A.Strakosha, A.Idrizi

Some problems related to the arterial-venous fistulae in hemodialized patients

Department of Surgery. Central Military University Hospital, Tirane, Albania



Abstract

With the aim to improve patency of arterial-venous fistulae life in patients with end stage kidney insufficiency we studied the results and problems got in such patients who underwent operation for arterial-venous fistulae creation. Our study includes 101 patients were vascular access for hemodialysis was necessary. The period of the study is May 2005-September 2009.as it will come out by the study we need to have a better control of the disease process and improve the cooperation between nephrology and surgery departments.

Key words :

arterial-venous fistulae, hemodialized patients



Introduction

Since the patients in end stage chronic renal insufficiency is increased in about 8 % per year and more patients need arterial-venous fistula for hemodialises access the problems related to them are getting more in frequency and the difficulty of resolving them is higher. Such patients have high cost of medical and social services. They need more access in operating room and radiology department since creation and preservation of an arterial-venous fistula is of a crucial importance in a complete and with good results hemodialyses process.

Aim of the study is determination of possible factors of failure according to the collected experience in creating arterial-venous fistulae [avf].

Material and Methods: Study period is May 2005-September 2009.We operated 101 patients in end stage of chronic renal insufficiency [CRI].Of the patient 60 were males and 41 females. Age amplitude ranged 17-70 years old. We created 112 new avf. According to the surgical procedure 47 cases radio-cephalic avf were performed, 53 brachial-cephalic avf, 6 ulnar-basilic avf and 6 cases were artificial prosthesis was used [tab 1]. All patients suffered end stage CRI with blood creatinine level ranging 7.5-13 mg/dl.

avf related to the surgical procedure

Tab. 1. avf related to the surgical procedure


Results:

In 76 patients avf had no problems. In 25 patients reoperation is needed. Patency rate was six months 83 %, 1 year 78 %, 4 years 72 % [TAB 2].

Reoperations have consisted:

New avf 11 procedures, angioplasty 16 procedures, hemostasis due to wound bleeding 7 cases.

Patency of avf

Tab. 2. Patency of avf.


Discussion:

The patency of avf is increased if a better follow up of the patients in the nephrology department can be done. The patients should be referred for surgery when creatinine clearance less than 25 ml/min, blood creatinine level is more than 4 mg/dl or when the patient will need hemodyalizes within one year. Differently by other studies done in USA and Europe, where central venous catheters have been used 60 % and 50 % respectively, in our patients they have been used in 95 % of patients. Another problem with our patients was secondary blood hypertension and anemia. All patients suffered stage 2-3 of blood hypertension and 90 % had grave stage of anemia. As it can be seen in the material all our patients had creatinine levels more than 7.5 mg/dl and not as it is recommended by the Dialysis Outcomes Quality Initiative [DOQI].In about 20 % of the patients diabetes mellitus was present and in 73 % of all patients exhausted venous net made surgical procedure more difficult. Thereby about 85 % of our patients underwent hemodialises using avf access between 4-6 weeks after avf creation and only 15 % exceeded 6 weeks of avf first puncture.

Conclusions:

The patency of avf can improve if patients suffering end stage CRI are referred earlier for avf creation in the surgery department. Also a better control of secondary disease and preservation of venous net will help the surgeon to perform a better kind of quality of avf.

References:

  1. Brescia,M.J.;Cimino, J.E.;Appel,K.; Harwich, B.J. Chronic Hemodialysis Using Venipuncture and Surgically Created Arteriovenous Fistula. N. Engl. J. Med. 1966, 275, 1089.
  2. Sterling, W.A.; Hazel, L.T.; Diethelm, A.G. Vascular Access for Hemodialysis by Bovine Graft Arteriovenous Fistulas. Surg. Gynecol. Obstet. 1975, 141, 69.
  3. Dardik, H.; Ibrahim, I.M.; Dardik, I. Arteriovenous Fistulas Constructed with Modified Human Umbilical Cord Vein Graft. Arch. Surg. 1976, 111, 60.
  4. Culp, K.; Flanigan, M.; Taylor, L.; Rothstein, M. Vascular Access Thrombosis in New Hemodialysis Patients. Am.J. Kidney Dis. 1995, 26, 341.
  5. Cohen, M.A.H.; Kumpe, D.A.; Durham, J.D.; Zwerdlinger, S.C. Improved Treatment of Thrombosed Hemodialysis Access Sites with Thrombolysis and Angioplasty. Kidney Int. 1994, 46, 1375.
  6. Marston, W.A.; Criado, E.; Jaques, P.F.; et al. Prospective Randomized Comparison of Surgical Versus Endovascular Management of Thrombosed Dialysis Access Grafts. J. Vasc. Surg. 1997, 26, 373.

 


Contact author: Arben Zenelaj

E-mail: arbenzeneli@yahoo.com

PDF - версия статьи

PDF - версия статьи

 

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