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A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail
Published on: February 3, 2016
Surgical Challenges In Managing Haemodialysis Arteriovenous Fistula Complications In Tertiary Care Centre: Our
Kritikalpa Behera1, Ajit Kumar Padhy1, Manju Gupta1
1Department of Cardiothoracic and Vascular Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Insights
Arteriovenous (AV) fistula rupture is the primary reason for surgical takedown in hemodialysis patients. Early detection and proper fistula care can improve outcomes and prevent complications like limb ischemia.
Area of Science:
- Vascular Surgery
- Nephrology
- Dialysis Access
Background:
- Arteriovenous (AV) fistula creation is essential for hemodialysis in chronic kidney disease (CKD) patients.
- Fistula function impacts dialysis quality and patient survival.
- Thrombosis and rupture are common reasons for AV fistula takedown.
Purpose of the Study:
- To review the surgical management of AV fistula complications.
- To analyze the experience with AV fistula takedown procedures.
Main Methods:
- Retrospective study of 29 patients undergoing AV fistula takedown.
- Data collected over a 3-year period (May 2021 - May 2024).
Main Results:
- Rupture was the most frequent cause for takedown (86.21%).
- All 29 patients underwent AV fistula takedown.
- Arterial ligation was performed in infected cases (75.86%); arterial continuity was maintained in non-infected cases.
- No aneurysms, pseudoaneurysms, or limb ischemia were observed during follow-up (1 month - 3 years).
Conclusions:
- Improper cannulation and inadequate fistula care lead to AV fistula complications.
- Early detection and presentation improve limb salvage and reduce morbidity/mortality.
Introduction:
Arteriovenous (AV) fistula creation is the most common surgical procedure for providing vascular access for haemodialysis in patients with chronic kidney disease (CKD). The functioning of fistula dictates the quality of dialysis and the longevity of patients. The most common circumstances that require surgical takedown of AV fistula are thrombosis and rupture. While some patients undergo elective AV fistula takedown post renal transplantation or for cosmesis, majority of patients presenting with life-threatening rupture require emergency surgery for AV fistula takedown with or without maintaining arterial continuity. This study aims to compile our experience with surgical management of various AV fistula complications.
Methods:
This is a retrospective study of 29 patients who underwent Arteriovenous Fistula takedown in our institute over a period of 3years from May 2021 to May 2024.
Results:
The most common cause of fistula takedown in our setup was rupture (n=25, 86.21%). AV fistula takedown was done in all cases (n=29, 100%). Arterial ligation was done in all infected cases (n=22, 75.86%) whereas in non-infected cases arterial continuity was maintained by repair or interposition venous graft. There was no aneurysm or psedoaneurysm formation or limb ischaemia in a follow up period ranging from 1month to 3 years.
Conclusion:
Erroneous ways of cannulation and lack of awareness of fistula care were the prime cause of AV fistula complications. Early detection and presentation to healthcare setup could offer a better prognosis for limb salvage in the long term and decrease the incidence of morbidity and mortality.
