Advertisment
Indian Journal of Nephrology About us |  Subscription |  e-Alerts  | Feedback | Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Current Issue | Archives| Ahead of print | Search |Instructions |  Editorial Board  

Users Online:100

Official publication of the Indian Society of Nephrology
 
ORIGINAL ARTICLE
Ahead of Print

Primary failure of autogenous arteriovenous fistula: Critical analysis


1 Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Nephrology, Army Hospital (R&R), New Delhi, India
3 Department of Plastic Surgery, Command Hospital, Kolkata, West Bengal, India

Correspondence Address:
Pavitra Manu Dogra,
Department of Nephrology, Army Hospital (R&R), New Delhi - 110 010
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_214_19

Introduction: Permanent vascular access is an essential intervention in patients with advanced chronic kidney disease (CKD) and its success depends on various non-modifiable and modifiable factors. Considering the element of unpredictability and failure, we attempted to analyze various factors responsible for primary arteriovenous fistula (AVF) failure in presumed high-risk groups. Materials and Methods: We conducted an observational study of newly created AVFs at a tertiary referral government hospital in Eastern India between January 2014 and June 2015. All adult CKD patients undergoing AVF creation were included. Primary AVF failure was assessed at 12 weeks and total follow-up was 24 weeks in presumed high-risk groups of females, patients aged ≥65 years and those with diabetes mellitus. Results: Female gender was at a higher risk of primary AVF failure if aged ≥65 years (P = 0.0026), second AVF creation (P = 0.03), loupe magnification not used (P = 0.03), arterial plaque (P = 0.028), absent immediate thrill, and with radiocephalic AVF (P = 0.02). Absent immediate thrill (<0.0001) and AVF size ≤5 mm (P = 0.002) were important independent risk factors for primary failure. Diabetes or elderly age did not have additional risk, except with uncontrolled hypertension and female gender. Conclusion: Female gender was at a higher risk of poor unassisted AVF patency if their age was ≥65 years, had second AVF creation, loupe magnification not used or if arterial plaque was present. An absence of thrill immediately or at 24 hours or an AVF diameter ≤5 mm were independent intraoperative factors for poor outcome. On the contrary, diabetics, elderly males and intimal thickness were essentially noncontributors for AVF failure, except in few subsets.


Print this article
Search
 Back
 
  Search Pubmed for
 
    -  Venkatnarayanan R
    -  Dogra PM
    -  Bavdekar R
    -  Singh SK
    -  Mondal AK
 Citation Manager
 Article Access Statistics
 Reader Comments
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed45    
    PDF Downloaded3    

Recommend this journal

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