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 ORIGINAL ARTICLE
Year : 2013  |  Volume : 23  |  Issue : 3  |  Page : 191-195

Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis


1 Department of Plastic Surgery, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
2 Department of Nephrology, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
3 Department of Plastic Surgery, Sassoon Hospitals, Pune, Maharashtra, India

Correspondence Address:
P Sahasrabudhe
Plot 82, Lane 2, Natraj Society, Karvenagar, Pune - 411 052, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.111845

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This report describes our experience of arteriovenous fistula (AVF) creation as vascular access for hemodialysis (HD). Study has been carried out in Deenanath Mangeshkar Hospital, Pune from January 2004 to December 2009. A total of 271 AVFs were created in 249 patients. Maximum follow up was 7 years and minimum was 1 year. In this study of 271 cases of AVFs, there were 196 (72.3%) successful cases and 75 (27.7%) failures. Basilic vein was used in 77 (28.4%) cases, cephalic vein in 186 (68.6%), and antecubital vein in 8 (3%) cases. End (vein) to side (artery) anastomosis was done in 170 (63%) cases. Side to side anastomosis was done in 100 (37%) cases. On table bruit was present in 244 (90%) and thrill in 232 (85.6%) cases. During dialysis, flow rate >250 ml/min was obtained in 136 (50.4%) cases. In complications, 16 (5.9%) patients developed distal edema, 32 (11.8%) developed steal phenomenon. Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. During proximal side to side fistula between antecubital/basilic vein and brachial artery, breaking of first valve toward wrist helps to develop distal veins in forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in arm.






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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07