Arteriovenous Fistula Creation by Nephrologist: A Single Centre Experience

Abstract

Introduction: Arteriovenous Fistula (AVF) is the preferred vascular access with the least rate of complications and morbidities. Across the globe except European countries AVF is created predominantly by surgeons. There are very few experiences shared by Nephrologists from Indian subcontinent in creating AV fistulas and their follow up. The aim of this study was to assess preoperative factors affecting the outcome of AVF creation and the follow up of successfully created fistulas. Material and Methods: A prospective observational study was carried at our hospital over a period of six months from 01 October 2018 to 31 March 2019. All patients undergoing AVF creation by nephrologist from 01 October 2018 to 15 Feb 2019 were included in the study and each patient was followed for six weeks. Besides baseline parameter, history of Diabetes, hypertension and coronary and peripheral vascular disease were noted. All the perioperative findings like vascular calcification and Blood pressure were noted. All successful AVF were followed for six weeks with serial USG and Doppler at postoperative day 1, 2 week and 6 weeks. Results: A total of 20 (77%) out of 26 AVF were successfully created, The average age was 54.6±15.4 years, Among baseline parameters gender had statistical significance (p=0.03). During surgery more arterial diameter and hypertension were associated with successful outcome. During follow-up, both arterial and venous diameter as well as blood flow in artery and AVF had significant correlation between postoperative 1st, 2nd and 6th week (p<0.01). More than 35% and 80% of patients at 2 and 6 weeks respectively achieved criteria for successful maturation as per NKFKDOQI criteria and it was > 90% and 100% as per UAB criteria. Conclusion: Our experience suggest good outcome of AVF creation by nephrologist, even with those with risk factors for failure and non maturation. Also we suggest early cannulation of AVF at four weeks or earlier.