Time based success in creation of initiative arterio-venous fistula for patients with chronic renal failure need haemodialysis
AbstractBackground : Patients with chronic kidney disease need permanent vascular access for hemodialysis and the best choice is by surgically created arterio-venous fistula. Artificial AVF is a challenging surgery because it carries a high failure rate with increasing morbidity and mortality. Objectives : to highlight the importance of time factor (the time interval between the establishment of CKD to the time of creation of AVF) as a predictor factor affecting the outcome of surgery. Methodology : a retrospective descriptive analytic study of 216 patients ( 124 male and 92 female) all with chronic kidney disease underwent surgical creation of AVF for hemodialysis in the vascular unit at Sader teaching hospital/Basra, south of Iraq from 1st of January 2010 to 30th of June 2012. Results : the overall success rate was 55.55% and the failure rate was 44.45%, the causes of failure in sequence were inadequate vein (51%), technical difficulties (16.6%), fistula thrombosis (11.6%), bleeding (9.4%), false aneurysm (7.3%) and distal ischemia (4.1%), the patients followed up after 24 hours, 1 week, 1 month and 6 months. Conclusion : the outcome of the surgery is affected by the time interval between the establishment of diagnosis of CKD and the time of surgical creation of AVF, the success rate is decreased with increasing time interval and become abrupt after 6 months, while the failure rate is increasing smoothly with increasing time interval with peak increase being after 6 months.
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