Feasible Vascular Access for Hemodialysis and their Complications in 100 Patients (2016 - 2020 )

  • Jalal Jaafar Abdulhussein MBChB, FICMS in Cardiothoracic & Vascular Surgery
  • Kassem Mohammed Zaier MBChB, FICMS in Cardiothoracic & Vascular Surgery
  • Amjed Abdulridha Alhilo MBChB, FICMS in Cardiothoracic & Vascular Surgery
Keywords: Arteriovenous fistula, bracchiocephalic arteriovenous fistula, brescia cimino, vascular access for hemodialysis


Background: Veno-Arterial handling is an important clinical issue in the management of chronic hemodialysis patients. Several complications may occur during treatment period. Aim: The aims of this study were to determine the most feasible AVF site to be created for hemodialysis and their possible complications that may occur during treatment period. Patients and Methods: A cross sectional comparative study was conducted in Ibn – Alnafees teaching hospital retrospectively , Department of Thoracic and Vascular Surgery from 2016-2012. Necessary approvals were taken from the hospital adminstration regarding data collection .  One hundred patients with end stage renal disease were included in this study after signing a consent form. An arteriovenous fistula was created in different sites preparing them for chronic haemodialysis program. The evaluations were based on the most feasible site for AVF, complications that may occur during the treatment period in different sites. Results: Most of the patient (98%) had successful creation of arteriovenous fistula, only two patients (2%) were not fit. The most two common approaches were, Brachiocephalic and radiocephalic which represent 70% and 20% respectively, followed by Anterior transposition of Basilica vein,4%, Autogenous saphenous vein graft 2% while Gore-Tex graft and Femorofemoral Gore-Tex Loop graft represent only 1% for each. Complications were seen in (15%) of the patients. Fistula failure was seen in 3 patients, Wound infection 2 patients, Temporary edema 2 patients, Hematoma 2 patients and one patient for each of the following complications, Continuous serous discharge, Steal syndrome, Sudden closure, False aneurysm formation, Aneurysmal dilatation of the veins and Huge limb swelling. Conclusion: Radiocephalic and the brachiocephalic AVF are the two types of vascular access with the longest duration of function and Radiocephalic is the most feasible site.


• Silva TN, de Marchi D, Mendes ML, Barretti P, Ponce D. Approach to prophylactic measures for central venous catheter-related infections in hemodialysis: a critical review. Hemodial Int. 2014;18(1):15–23.

• Les J, Wankowicz Z. Methods of central vascular access for haemodialysis. Anaesthesiology intensive therapy. 2013;45(3):171–6.

• Di Iorio BR, Bellizzi V, Cillo N, Cirillo M, Avella F, Andreucci VE, et al. Vascular access for hemodialysis: the impact on morbidity and mortality. Journal of nephrology. 2004;17(1):19–25.

• Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. Journal of the American Society of Nephrology: JASN. 2005;16(5):1449–55.

• Santoro D, Benedetto F, Mondello P, Pipito N, Barilla D, Spinelli F, et al. Vascular access for hemodialysis: current perspectives. International journal of nephrology and renovascular disease. 2014;7:281–94.

• Monroy-Cuadros M, Yilmaz S, Salazar-Banuelos A, Doig C. Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clinical journal of the American Society of Nephrology: CJASN. 2010;5(10):1787–92.

• Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. Journal of the American Society of Nephrology: JASN. 2006;17(4):1112–27.

• Rodriguez-JA ;Armadans -L;Ferrer-E;01mos-A et ill The function of permanent vascular access , Nephrol-Dial -Transplant .2000 Mar; 15(3) ; 402 -8 .

• Wolowczyk-L: Williams -AJ; Donovan -KL; Gibbons-CP., The snuffbox arteriovenous fistula for vascular access, Eur-J-Vasc-Endovasc-Surg.2000 Jan. 19(1). (70-6).

• Waleed M. Hussain, vascular access of uremic patients, the Iraqi national journal for clinical sciences, vdl,no. 1, 2003.

• Allyn G.May ,Carl H. Andrus .Vascular access, Rob & Smith operative Surgery, Fourth edition, 1985, p(435-447)

• Le Sar CJ, Merrick HW, Smith MR .Thrombotic complication resulting from hypercoagulable in chronic haemodialysis vascular access. Department of Surgery, Medical College of Ohio,USA .Jam Coll Surg . 1999; 189 (1); 73-9.

• Stevenson-KB; Adeox-MJ; Mallea -MC; Et All Standardized surveillance of haemodialysis vascular access infections; Infect-Control-Hosp-Epidemiol. 2000 Mar; 21(3); 200- 3