Time based success in creation of initiative arterio-venous fistula for patients with chronic renal failure need haemodialysis


  • Muayyad M. Almudhafer College of medicine, university of Basra, Basra, Iraq.


Background : 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.  


. Mansfield PE, Hohn DC, Fornage BD, et al. Complications and failure of subclavian-vein catheterization. New Engl J Med 1994; 331: 1735-38.

Feldman HI, Kobrin S, Wasserstein A. hemodialysis vascular access morbidity. J Am Soc Nephrol 1996; 7:523.

Ascher E, Gade P, Hingorani A, et al. Changes in the practice of angio access surgery: impact of dialysis outcome and quality initiative recommendations. J Vas Surg 2000; 31:84.

Allon M, Robbin ML. increasing arteriovenous fistulas in hemodialysis

patients: problems and solutions. Kidney Int 2002; 62: 1109-24.

Dexon BS, Novak L, Fangman J, hemodialysis vascular access survival:

upper arm native arteriovenous fistula. Am J Kidney Dis 2002; 39:92.

Anel RL, Yevzlin AS, Ivanovich P. Vascular access and patient outcome in hemodialysis: questions answered in recent literature. Artif Organs

; 27:237.

Wang W, Murphy B, Yilmaz S, Tonelli M, Macrac J, Manns BJ. Co morbidities do not influence primary fistula success in incidental hemodialysis patient. J Vas Access 2007; 8:275-280.

Tadenusz M, Waldemar K. Estimation of predictive factors affecting

patency of dialysis after arteriovenous fistulae. ( medline ).

Woods JD, Port FK. The impact of vascular access for hemodialysis on patient morbidity and mortality. Nephrol Dial Transplant 1997; 12 : 657-9.

Asif A, Roy-Chandhury P, Beathard GA. Early arteriovenous fistula failure: A logical proposal for when and how to intervene. Clin J Am Soc Nephrol 2006; 1: 332-9.

Asif A, Cherla G, Merill D, Cipleu CD, Briones P, Pennell P. Conversion

of tunneled hemodialysis catheter consigned patients to arteriovenous fistula. Kidney Int 2005; 67 : 2399-407.

Miller PE, Tolwani A, Luscy CP, Deierhoi MH, Bailey R, Redden, et al.

predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999 ; 56 : 275-89.

Beathard GA, Arnold P, Jackson J, Litchfield T. Aggressive treatment of

early fistula failure. Kidney Int 2003 ; 64 : 1487-94.

Roy-Chaudhury P, Kelly BS, Zhang J, Narayana A, Desai P, Melham M, et al. Prevention of P.O. clotting of AV cimino fistulas with acetylsalicylic acid : Results of a prospective double blind study. Klin wochenschr 1974 ;

: 348-9.

Carrie A. Schinstok, Robert C. Albright, Karl A. Nath. Outcome of arteriovenous fistula creation after the fistula first initiative. Clin J Am Soc Nephrol 2011 August; 6(8)

: 1996-2002.

Feldman HI, Joffe M, Rosas SE, Burns JE, Knauss J, Brayman K. Predictors of successful arteriovenous fistula maturation. Am J Kidney dis; 42 : 1000-1012, 2003.

Huijbergts HT, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PT. Hemodialysis arteriovenous fistula patency revisited : Results of prospective multicenter initiative. Clin J Am Soc Nephrol 3: 714-719, 2008.

Oliver MJ, Rothwell DM, Fung K, et al. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephro 2004;15:936-42.

Rooijens PP, Tordoir JH, Stejinen T, Burgmans JP, Smet de AA, et al. Radio cephalic wrist arteriovenous fistula for hemodialysis : meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc surg 2004;28:583-9.

Vassalotti JA, Falk A, Cohl ED, Uribarri J, Teodorescu V. obese and non- obese hemodialysis patients have a similar prevalence of functioning arteriovenous fistula using pre-operative vein mapping. Clin Nephrol 2002;58:211-14.

Chan MR, Young HN, Becker YT, Yevzlin AS. Obesity as a predictor of vascular access outcome: Analysis of the USRDS DMMS Wave II study. Semin Dial 2008;21:274-9.