Outcome of End to Side Arterio-venous Fistula for Chronic Hemodialysis Patients at Nawaz Sharif Kidney Hospital Swat: A Cross Sectional Study

Abstract

Background: End stage renal disease (ESRD) is associated with irreversible kidney function decline. Total number of ESRD
patients is increasing dramatically and became major public health concern, globally. Arterio venous (AV) fistula for hemodialysis is
gold standard for vascular access. A subcutaneous anastomosis of an artery to adjacent vein is termed as AVF.
Objective: To determine outcome of end to side Arterio-venous fistula in terms of AVF functioning, primary patency, maturation and
associated complications
Material and Methods: A cross sectional study was conducted in department of urology at Nawaz Sharif Kidney Hospital Swat.
Study duration was one year (April 2017- April 2018). Sample size of 195 patients was calculated using WHO calculator with 5%
significance, 95% confidence interval, 85% Patency (primary patency). Patients were recruited through non probability
consecutive sampling. Ethical approval and consent forms were taken. After pre-operative assessment, radio-cephalic and elbow
fistula were created where feasible. Post operatively patients were followed after one month. Data was analyzed using SPSS
version 22.0. Chi-square test was applied to observe associations. P value =0.05 was considered significant.
Results: Total 195 patients were included in study. There were 101(51.8%) males and 94(48.2%) females. Mean age of patients
was 51 years±12.04 SD. The AVF site was radio-cephalic in 169(86.7%), cubital fossa in 23(11.8%) and Brachio-median cubital
AVF in 3(1.5%) patients. AVF functioning was immediate in 116(59.5%), delayed in 51(26.2%) and non-functional in 28(14.4%)
patients. Primary patency was low in 85(43.6%) patients, moderate in 58(29.7%) and better in 52(26.7%) patients. AVF maturation
was reported in 159(81.5%). Thrombosis was most common complication (25.1%). AVF functioning is significantly associated with
gender (p=0.00), early thrombosis (p=0.01), late thrombosis (p=0.01), stenosis (p=0.00) and primary patency (p=0.00).
Conclusion: Arterio-venous fistula (AVF) is gold standard for vascular access with functional rate 47.4%, high degree of
maturation and better primary patency. This specialized surgery should be done & referred to those surgeons who are well versed
in vascular surgery, knows their limitations & are cognizant of the principles of vascular surgery. Thrombosis is most common
complication of subsequent procedure. Further research is required on pathophysiology of thrombosis