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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(03): 257-263
DOI: 10.1055/s-0041-1734576
CME Article

Nuances of Arteriovenous Fistula Creation for Vascular Access in Hemodialysis

Parag Sahasrabudhe
1   Department of Plastic Surgery, B.J. Govt. Medical College & Sassoon Hospitals, Pune, Maharashtra, India
2   Depatment of Plastic Surgery, Deenanath Hospital, Pune, Maharashtra, India
,
Ameya Bindu
3   Depatment of Plastic Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Abstract

Background With rising incidence and increased life expectancy of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), the number of patients requiring hemodialysis has increased substantially. Vascular access is the lifeline for a patient on hemodialysis (HD), and an arteriovenous fistula (AVF) is the undisputed gold standard for HD access. An effective and long-lasting fistula serves to increase the life expectancy of ESRD patients and improves their quality of life.

Learning Objectives This paper aims to give a comprehensive overview of AVF creation, including the various techniques, patient selection, troubleshooting with decision-making, and common complications. Authors share their experience from previous publications and over 2000 AVF surgeries. They have not only described a new modification of the technique of proximal fistula but have also established a direct correlation between bruit and thrill on operation table and success of fistula surgery.

Conclusion A standardized, protocol-driven multidisciplinary approach with careful patient and site selection, guided by outcome predictors, is vital in AVF surgery. Knowledge about the potential complications of AVFs contributes to their timely detection and allows measures to be taken that might prevent deleterious consequences that range from loss of vascular access to serious morbidity and mortality.

Keywords

arteriovenous fistula - vascular access - guidelines - hemodialysis - chronic kidney disease - ESRD


Publication History

Article published online:
08 September 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Singh AK, Farag YM, Mittal BV. et al Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol 2013; 14: 114
    CrossrefPubMedGoogle Scholar
  • 2 Varughese S, Abraham G. Chronic kidney disease in India: a clarion call for change. Clin J Am Soc Nephrol 2018; 13 (05) 802-804
    CrossrefPubMedGoogle Scholar
  • 3 Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey RM. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant 2005; 20 (08) 1638-1642
    CrossrefPubMedGoogle Scholar
  • 4 Jha V. Current status of end-stage renal disease care in India and Pakistan. Kidney Int Suppl 2013; 3: 157-160
    CrossrefGoogle Scholar
  • 5 Schwab SJ. Hemodialysis vascular access: the Achilles’ heel remains. Kidney Int 2007; 72 (06) 665-666
    CrossrefPubMedGoogle Scholar
  • 6 Arora P, Kausz AT, Obrador GT. et al Hospital utilization among chronic dialysis patients. J Am Soc Nephrol 2000; 11 (04) 740-746
    CrossrefPubMedGoogle Scholar
  • 7 Modi G, Jha V. Incidence of ESRD in India. (Letter to editor. Kidney Int 2011; 79: 573
    CrossrefPubMedGoogle Scholar
  • 8 NKF-K/DOQI. Clinical Practice Guidelines for Vascular Access: Update 2000. Am J Kidney Dis 2001; 37 (01) , Suppl 1) S137-S181
    CrossrefPubMedGoogle Scholar
  • 9 NKF-K/DOQI, Vascular Access Work group. Clinical Practice Guidelines for Vascular Access: Update. Am J Kidney Dis 2006; 48 (Suppl. 01) s176-s322
    CrossrefPubMedGoogle Scholar
  • 10 Jindal K, Chan CT, Deziel C. et al Canadian Society of Nephrology Committee for Clinical Practice Guidelines. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17 (03) , Suppl 1) S1-S27
    CrossrefPubMedGoogle Scholar
  • 11 Tordoir JH, Van Der Sande FM, De Haan MW. Current topics on vascular access for hemodialysis. Minerva Urol Nefrol 2004; 56 (03) 223-235
    PubMedGoogle Scholar
  • 12 Young EW, Dykstra DM, Goodkin DA, Mapes DL, Wolfe RA, Held PJ. Hemodialysis vascular access preferences and outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS. Kidney Int 2002; 61 (06) 2266-2271
    CrossrefPubMedGoogle Scholar
  • 13 van Andringa de Kempenaer T, ten Have P, Oskam J. Improving quality of vascular access care for hemodialysis patients. Jt Comm J Qual Saf 2003; 29 (04) 191-198
    PubMedGoogle Scholar
  • 14 Kong NC, Morad Z, Suleiman AB. Subclavian catheters as temporary vascular access. Singapore Med J 1989; 30 (03) 261-262
    PubMedGoogle Scholar
  • 15 Roy-Chaudhury P, Kelly BS, Melhem M. et al Vascular access in hemodialysis: issues, management, and emerging concepts. Cardiol Clin 2005; 23 (03) 249-273
    CrossrefPubMedGoogle Scholar
  • 16 Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ. CIMINO study group. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008; 3 (03) 714-719
    CrossrefPubMedGoogle Scholar
  • 17 Gh K, Mhs M. H R, M D, L H, M N.. Primary patency rate of native AV fistula: long term follow up. Int J Clin Exp Med 2012; 5 (02) 173-178
    PubMedGoogle Scholar
  • 18 Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275 (20) 1089-1092
    CrossrefPubMedGoogle Scholar
  • 19 Levey AS, Coresh J, Greene T. et al Chronic Kidney Disease Epidemiology Collaboration. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007; 53 (04) 766-772
    CrossrefPubMedGoogle Scholar
  • 20 Lok CE. Fistula first initiative: advantages and pitfalls. Clin J Am Soc Nephrol 2007; 2 (05) 1043-1053
    CrossrefPubMedGoogle Scholar
  • 21 Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist’s perspective. Semin Dial 2007; 20 (01) 53-62
    CrossrefPubMedGoogle Scholar
  • 22 Moist LM, Lok CE, Vachharajani TJ. et al Optimal hemodialysis vascular access in the elderly patient. Semin Dial 2012; 25 (06) 640-648
    CrossrefPubMedGoogle Scholar
  • 23 Tordoir J, Canaud B, Haage P. et al EBPG on vascular access. Nephrol Dial Transplant 2007; 22 (Suppl. 02) ii88-ii117
    PubMedGoogle Scholar
  • 24 Sahasrabudhe P, Dighe T, Panse N, Deshpande S, Jadhav A, Londhe S. Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature. Indian J Plast Surg 2014; 47 (03) 362-369
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Sahasrabudhe P, Dighe T, Ambekar N. et al Study of efficacy and functionality of modified technique of proximal arteriovenous fistula as a vascular access for haemodialysis: A retrospective analysis of 171 cases. Med J DY PatilVidyapeeth 2019; 12: 139-144
    CrossrefGoogle Scholar
  • 26 Ene-Iordache B, Cattaneo L, Dubini G, Remuzzi A. Effect of anastomosis angle on the localization of disturbed flow in ‘side-to-end’ fistulae for haemodialysis access. Nephrol Dial Transplant 2013; 28 (04) 997-1005
    CrossrefPubMedGoogle Scholar
  • 27 Pousset Y, Lermusiaux P, Berton G. Le Gouez JM, Leroy R. Numerical model study of flow dynamics through an end-to-side anastomosis: choice of anastomosis angle and prosthesis diameter. Ann Vasc Surg 2006; 20 (06) 773-779
    CrossrefPubMedGoogle Scholar
  • 28 Robbin ML, Greene T, Cheung AK. et al Hemodialysis Fistula Maturation Study Group. Arteriovenous fistula development in the first 6 weeks after creation. Radiology 2016; 279 (02) 620-629
    CrossrefPubMedGoogle Scholar
  • 29 Berman SS, Mendoza B, Westerband A, Quick RC. Predicting arteriovenous fistula maturation with intraoperative blood flow measurements. J Vasc Access 2008; 9 (04) 241-247
    CrossrefPubMedGoogle Scholar
  • 30 Sahasrabudhe P, Dighe T, Panse N, Patil S. Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis. Indian J Nephrol 2013; 23 (03) 191-195
    CrossrefPubMedGoogle Scholar
  • 31 Beathard GA, Arnold P, Jackson J, Litchfield T. Physician Operators Forum of RMS Lifeline. Aggressive treatment of early fistula failure. Kidney Int 2003; 64 (04) 1487-1494
    CrossrefPubMedGoogle Scholar
  • 32 Silva Jr MB, Hobson II RW, Pappas PJ. et al A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27 (02) 302-307 discussion 307–308
    CrossrefPubMedGoogle Scholar
  • 33 Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ. CIMINO study group. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008; 3 (03) 714-719
    CrossrefPubMedGoogle Scholar
  • 34 Falk A. Maintenance and salvage of arteriovenous fistulas. J Vasc Interv Radiol 2006; 17 (05) 807-813
    CrossrefPubMedGoogle Scholar
  • 35 Roy-Chaudhury P, Melhem M, Husted T, Kelly BS. Solutions for haemodialysis vascular access dysfunction: thinking out of the box. J Vasc Access 2005; 6: 3-8
    CrossrefPubMedGoogle Scholar
  • 36 Lee T, Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis. Adv Chronic Kidney Dis 2009; 16 (05) 329-338
    CrossrefPubMedGoogle Scholar
  • 37 Lee T. Haemodialysis vascular access dysfunction. In: Carpi A, Donaldio C, Tramonti G, eds. Progress in Haemodialysis – From Emergent Biotechnology to Clinical Practice. Rijeka: InTech 2011: 365-388
  • 38 Bachleda P, Kojeckǽ Z, Utíkal P, Drác P, Herman J, Zadrazil J. Peripheral venous hypertension after the creation of arteriovenous fistula for haemodialysis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2004; 148 (01) 85-87
    CrossrefPubMedGoogle Scholar
  • 39 Saeed F, Kousar N, Sinnakirouchenan R, Ramalingam VS, Johnson PB, Holley JL. Blood loss through AV fistula: a case report and literature review. Int J Nephrol 2011; 2011: 350870
    CrossrefPubMedGoogle Scholar
  • 40 DeCaprio JD, Valentine RJ, Kakish HB, Awad R, Hagino RT, Clagett GP. Steal syndrome complicating hemodialysis access. Cardiovasc Surg 1997; 5 (06) 648-653
    CrossrefPubMedGoogle Scholar
  • 41 Zamani P, Kaufman J, Kinlay S. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis. Vasc Med 2009; 14 (04) 371-376
    CrossrefPubMedGoogle Scholar
  • 42 Davidson D, Louridas G, Guzman R. et al Steal syndrome complicating upper extremity hemoaccess procedures: incidence and risk factors. Can J Surg 2003; 46 (06) 408-412
    PubMedGoogle Scholar
  • 43 Basile C, Lomonte C, Vernaglione L, Casucci F, Antonelli M, Losurdo N. The relationship between the flow of arteriovenous fistula and cardiac output in haemodialysis patients. Nephrol Dial Transplant 2008; 23 (01) 282-287
    CrossrefPubMedGoogle Scholar
  • 44 Tan TL, May KK, Robless PA, Ho P. Outcomes of endovascular intervention for salvage of failing hemodialysis access. Ann Vasc Dis 2011; 4 (02) 87-92
    CrossrefPubMedGoogle Scholar
  • 45 Bender MH, Bruyninckx CM, Gerlag PG. The Gracz arteriovenous fistula evaluated. Results of the brachiocephalic elbow fistula in haemodialysis angio-access. Eur J Vasc Endovasc Surg 1995; 10 (03) 294-297
    CrossrefPubMedGoogle Scholar
  • 46 Miller PE, Carlton D, Deierhoi MH, Redden DT, Allon M. Natural history of arteriovenous grafts in hemodialysis patients. Am J Kidney Dis 2000; 36 (01) 68-74
    CrossrefPubMedGoogle Scholar
  • 47 Akoh JA. Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access 2009; 10 (03) 137-147
    CrossrefPubMedGoogle Scholar
  • 48 Mosquera D. Regarding “Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study”. J Vasc Surg 2003; 37 (01) 238-239
    CrossrefPubMedGoogle Scholar