A Prospective Study Of Outcome Of Arteriovenous Fistula By Prior Assessment Of Vascular Dimensions

Abstract

Purpose: The population of patients with ESRD is increasing. Hemodialysis is the major mode of renal replacement therapy. Arterio-venous fistulae (AVF) are the preferred access for HD. Of the three types of hemodialysis vascular access, arteriovenous fistulae (AVF) have higher patency rates, lower infection rates, and lower overall costs1 than either grafts or catheters. The number of potential VA sites for HD per subject is limited. Therefore, measures to improve the longevity of VA are needed. AVF failures have been attributed to inadequate vessels used for surgery. Preoperative evaluation with Doppler ultrasonography (USG) is an excellent choice and may facilitate selection of suitable vessels and reduces AVF failures. Objective of the study: 1) To assess the efficacy of vascular sonographic mapping before haemodialysis access placement. 2) To correlate pre-operative sonographic vascular mapping with operative findings (determined by anatomy, vessel size, patency and wall morphology) and subsequent surgical outcomes. Materials & Methods: Patients of end stage renal disease posted for haemodialysis access in department of general medicine and nephrology at KLE’S Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehrunagar, Belgaum, between January 2015 to December 2015. Results: Majority of patients were between the age group of 61-70 years (40%). Among 50 cases of CKD, 70% cases were secondary to DM, followed by hypertension (16%),Ischemic heart disease(8%), other diseases (6%). Majority of patients underwent radio cephalic fistula placement (54%) followed by brachiobasilar (18%), followed by braciocephalic (10%) and surgery was considered in opposite hand (right) in 18% of cases.Among diabetic patients 45% underwent radiocephalic fistula,25% underwent brachiobasilar. Correlation was done between preoperative findings by ultrasound Doppler and intraoperative findings by micrometer calliper. Significant correlation was found with radial artery(0.0058),cephalic vein(0.0001),brachial artery(0.0317),but no significant correlation was found with basilar vein.patients were followed on third postoperative day and at 3 months which showed patency of 100% and 88%. Conclusion: Preoperative sonographic vascular mapping prior to haemodialysis access placement helps to facilitate definite selection of potential sites. The sonographic vascular mapping also helps in maximising the placement of native AVFs by reducing incidence of negative surgical exploration and increasing patency rates.