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Vascular access for haemodialysis--experience at Johannesburg Hospital
Insights
This study reviews arteriovenous fistulas for hemodialysis access, finding autogenous fistulas have better long-term patency than synthetic grafts. Needle choice impacts hemolysis during dialysis.
Area of Science:
- Nephrology
- Vascular Surgery
- Dialysis Access
Background:
- End-stage renal failure necessitates reliable hemodialysis access.
- Arteriovenous fistulas (AVFs) and synthetic grafts are common access types.
- Complications and patency rates vary between access modalities.
Purpose of the Study:
- To review experience with angio-access in hemodialysis patients.
- To compare patency rates and complications of autogenous AVFs versus synthetic grafts.
- To evaluate the impact of dialysis needle gauge on hemolysis.
Main Methods:
- Retrospective review of 137 autogenous AVFs (Group 1) and 33 synthetic grafts (Group 2).
- Patency rates assessed at 2 and 4 years.
- Complications documented, including thrombosis, aneurysm, sepsis, and operative technique.
- Comparison of dialysis needles of different gauges, focusing on hemolysis.
Main Results:
- Autogenous AVFs showed 2-year patency of 66% and 4-year patency of 47%.
- Synthetic grafts had lower patency rates: 44% at 2 years and 36% at 4 years.
- Common complications included thrombosis, aneurysm (AVFs), and sepsis (grafts).
- No correlation found between fibrinogen levels and access failure.
- The 16-gauge Terumo needle caused no hemolysis and was suitable for dialysis.
Conclusions:
- Autogenous arteriovenous fistulas demonstrate superior long-term patency compared to synthetic grafts for hemodialysis access.
- Thrombosis and technical issues are key complications for AVFs, while sepsis is a concern for grafts.
- Appropriate dialysis needle selection, like the 16-gauge Terumo, is crucial to prevent hemolysis.
Abstract:
Experience with angio-access in patients with chronic end-stage renal failure undergoing haemodialysis, including those with arteriovenous fistulas constructed within the past 3 years, is reviewed. In patients in group 1, 137 fistulas were constructed; the patency rate at 2 years was 66% and at 4 years 47%. Complications were due to thrombosis, aneurysm and poor operative technique. In group 2 fistulas were constructed from synthetic material in 33 patients; the patency rate at 2 years was 44% and at 4 years 36%. Complications were due to thrombosis and sepsis. No correlation was found between raised fibrinogen levels and fistula or graft failures. Dialysis needles of different gauges were compared; the 16-gauge Terumo needle was found to cause no hemolysis and was adequate for use in dialysis.