Outcome of Haemodialysis Arteriovenous Fistula in Baghdad, Iraq

Abstract

Background: Vascular access (VA) is the life line for end stage renal disease (ESRD). Though there are many methods of VA, native arteriovenous fistula (AVF) is the oldest and the best. AVFs are prone to develop some complications. The aim of this combined prospective and retrospective clinical study was to assess the outcome of native haemodialysis AVF in Baghdad Medical City Teaching Hospital, Baghdad, Iraq. Materials and Methods: Sixty-seven patients (43 males and 24 females) with ESRD were studied over 6 months, from April 1 to September 30, 2013. Demographic and clinical features as well as co-morbidities were checked. Allen’s test and examination of upper limb superficial veins were performed. Radio-cephalic or brachio-cephalic AVFs were created mostly under local anaesthesia using artery-side to vein-end anastamoses. Complications were noted during a follow-up period of 2 weeks to 6 months. Results: The mean age was 51.2 ± 14.4 years. Fistulas (n = 81) were mostly brachio-cephalic (n = 74, 91.4%). One fifth of patients were diabetics and 58.2% were hypertensive. End of the vein to side of the artery was used in 92.5%. All fistulae functioned primarily. Significant complications were thrombosis (n = 18, 22.2%), aneurysms (n = 3, 4.5%) and steal syndrome (n = 3, 13.6%). Distal oedema, venous congestion, wound infection and seroma were managed conservatively. Three surgical revisions were required, one for a large aneurysmal dilation (aneurysmectomy and vessel ligation) and two for an evacuation of seroma. Conclusion: AVF initial success was good. Late complications such as aneurysms and steal syndrome were almost within the reported rates whilst thrombosis was high.