Outcome of Arterioveous Fistulae in Patients with End Stage Renal Disease

Abstract

Background: Vascular access has been the corner stone for renal replacement therapy. This study was conducted to assess the outcome of arteriovenous fistulae in patients with end stage renal disease in terms of stomal diameter and blood flow rate.

Methodology: It was a descriptive study carried out in Surgical C Unit of Khyber Teaching Hospital, Peshawar from March 2004 to July 2006. All the study participants underwent arteriovenous fistula construction surgery as advised by nephrologist. Patients irrespective of the site of anastomosis were examined by color doppler ultrasound for stomal opening size and flow rate measurements. All patients were followed for 6 months. The data was analysed using SPSS version 12.0.

Results: A total of 92 patients with end stage renal disease were included in the study. The mean age was 42.9±13.1 years and majority were men (63%). 42.39% of the patients were hypertensive and an equal percentage was diabetic. The patients having the ESRD history of six or more months were 57.6%. During the course of study, 15.2% of the constructed AVF failed. The blood flow rate across each of AVF recorded by doppler ranged from 160-820 ml/min (Mean 527.5±177.8). All of the AVF with flow rate of less than 300 ml/min failed. The stomal diameter ranged from 2.3-9.8 mm (Mean 4.3±1.7). Most (77.7%) of the AVF having less than 3.5 mm of stomal diameter failed. Overall, majority of the failed AVF belonged to the age group of 20-39 years (57.1%), married status (71.4%) and male gender (71.4%). 50% of the failed group of AVF patients were hypertensive while 64.2% were diabetics. 86% of proximal fistulae in comparison to 83.7% of distal fistulae were found to be patent and successful at the end of the study.

Conclusion: The blood flow rate of less than 300ml/min and stomal diameter of less than 3.5 mm is critical for the future failed outcome of AVF within six months of construction surgery.