Arteriovenous Fistula (AVF) Creation Surgery in the Light of Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines at a Tertiary Care Hospita

Muhammad Ismail; Ahsin  Manzoor Bhatti; Rizwan  khan; Mohsin  Shahzad; Azaz  Ayubi; Athar Badshah

doi:10.51253/pafmj.v76i5.12773

Authors

Muhammad Ismail Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ahsin Manzoor Bhatti Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Rizwan khan Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Mohsin Shahzad Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Azaz Ayubi Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Athar Badshah Department of Vascular Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i5.12773

Keywords:

Arteriovenous Fistulas, Cannulation, Dialysis, End Stage Renal Disease, Rule of Six

Abstract

Objective: To review the Arteriovenous Fistula (AVF) creation surgery in the light of Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.

Study Design: Prospective analytical study.

Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from Jul 2023 to Sep 2024.

Methodology: A total of 404 patients with End-Stage Renal Disease (ESRD) requiring hemodialysis were operated upon for Arteriovenous Fistula (AVF). They were followed up for six dialysis sessions post-surgery. The adequacy and post-op complications of AVFs were evaluated using clinical examination, duplex ultrasound, and urea-based methods up till six dialysis. AVFs were created using standard end-to-side technique.

Results: There were 404 patients in our study, with an 88.02% follow-up rate, the mean age of population was 57.36. AVF adequacy for maturation was achieved in 84.9% patients within six weeks, and most fistulas demonstrated sufficient blood flow rates for dialysis. Out of these, 73(18.1%) of fistulas were non-functional with 54 primary (13.4%) and 19 early (4.7%), with thrombosis being a common complication. No standard cannulation technique, nor ultrasonography was used. Radio-cephalic fistula was the most common to fail. Of the early failures, thrombosis was the most common complication (n=14, 42.4%) followed by pseudoaneurysm (n=9, 27.3%).

Conclusion: Pre-dialysis referral, detailed patient planning, and continuous clinical and radiological monitoring are crucial for improving fistula success outcomes. The classic "rule of six" for AVF success is good but clinicoradiological judgement is superior, advocating for a more tailored approach.

Downloads

Download data is not yet available.

References

1. Imtiaz S, Alam A. Epidemiology and demography of chronic kidney disease in Pakistan—a review of Pakistani literature. Pak J Kidney Dis 2023; 7(1): 2-7.

https://doi.org/10.53778/pjkd71209

2. Hasan M, Sutradhar I, Gupta RD, Sarker M. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrol 2018; 19(1): 1-12.

https://doi.org/10.1186/s12882-018-1072-5

3. Donca IZ, Wish JB. Systemic barriers to optimal hemodialysis access. Semin Nephrol 2012; 32(6): 519-529.

https://doi.org/10.1016/j.semnephrol.2012.10.002

4. Raimann JG, Chu FI, Kalloo S, Zhang H, Maddux F, Wang Y, et al. Delayed conversion from central venous catheter to non-catheter hemodialysis access associates with an increased risk of death: A retrospective cohort study based on data from a large dialysis provider. Hemodial Int 2020; 24(3): 299-308.

https://doi.org/10.1111/hdi.12831

5. Singh NS, Grimes J, Gregg GK, Nau AE, Rivard DC, Fields M, et al. "Save the Vein" Initiative in Children With CKD: A Quality Improvement Study. Am J Kidney Dis 2021; 78(1): 96-102.

https://doi.org/10.1053/j.ajkd.2020.11.016

6. Nantakool S, Prasannarong M, Srisuwan T, Reanpang T, Apichartpiyakul P, Rerkasem K. Agreement between physical and ultrasound examination for arteriovenous fistula maturation diagnostics in Thai hemodialysis patients. J Vasc Access 2022; 23(1): 123-127. https://doi.org/10.1177/1129729820983177

7. Arif A, Haadi O, Bhatti AM, Ali Inam SH, Baig ZF, Cheema AH et al. Audit of Vascular Access Surgery in A Tertiary Care Hospital. Pak Armed Forces Med J 2022; 72(1): 155-158.

https://doi.org/10.51253/pafmj.v72i1.5416

8. Huber TS, Berceli SA, Scali ST, Neal D, Anderson EM, Allon M, et al. Arteriovenous fistula maturation, functional patency, and intervention rates. JAMA Surg 2021; 156(12): 1111-1119.

https://doi.org/10.1001/jamasurg.2021.4527

9. Azeem SM, Ehsan O, Khan MI. Patency and complications of arterio-venous fistula created in pre- and post-dialysis settings. J Coll Physicians Surg Pak 2022; 32(4): 510-513.

https://doi.org/10.29271/jcpsp.2022.04.510

10. Hsu CY, Iribarren C, McCulloch CE, Darbinian J, Go AS. Risk factors for end-stage renal disease: 25-year follow-up. Arch Intern Med 2009; 169(4): 342-350.

https://doi.org/10.1001/archinternmed.2008.605

11. Ali S, Shahzad I, Baloch MU. Arteriovenous fistula experience at a tertiary care hospital in Pakistan. Pak J Med Sci 2013; 29(1): 161-165. https://doi.org/10.12669/pjms.291.2753

12. Zhang H, Lu H, Li W, Jiang G, Zou H. Expert Group of Nephrology Branch of China Academy of Chronic Disease Urology Nephrology and Blood Purification Commission of China Medical Education Association. Expert consensus on the establishment and maintenance of native arteriovenous fistula. Chronic Dis Transl Med 2021; 7(4): 235-253.

https://doi.org/10.1016/j.cdtm.2021.05.002

13. Vachharajani TJ, Wong L, Niyyar VD, Abreo KD, Mokrzy MH. Buttonhole Cannulation of Arteriovenous Fistulas in the United States. Kidney360. 2020; 1(4): 306-313.

https://doi.org/10.34067/kid.0000052020

14. Labriola L. Should Buttonhole Cannulation of Arteriovenous Fistulas be Used? PRO. Kidney360 2020; 1(5): 318-321.

https://doi.org/10.34067/kid.0000702020

15. Siyar F, Jamil M, Ali K, Latif H, Pervaiz HK, Kharl RA. Threat analysis of reasons leading to failure of permanent haemodialysis access. Pak Armed Forces Med J 2021; 71(3): 861-865.

https://doi.org/10.51253/pafmj.v71i3.4797

16. Fila B, Ibeas J, Tey RR, Lovčić V, Zibar L. Arteriovenous fistula for haemodialysis: The role of surgical experience and vascular access education. Nefrologia 2016; 36(2): 89-94.

https://doi.org/10.1016/j.nefroe.2015.07.006

17. Tapia GI, Esteve SV, Ibañez PS, Moreno GF, Fulquet NM, Duarte GV, et al. Upper limb isometric exercise protocolled programme and arteriovenous fistula maturation process. Clin Kidney J 2020; 14(2): 688-695.

https://doi.org/10.1093/ckj/sfz194

18. Iglesias R, Lodi M, Rubiella C, Teresa PM, Ibeas J. Ultrasound guided cannulation of dialysis access. J Vasc Access 2021; 22(1_suppl): 106-112.

https://doi.org/10.1177/11297298211047328

19. Eves J, Cai P, Latham R, Leung C, Carradice D, Chetter I, et al. A randomised clinical trial of ultrasound guided cannulation of difficult fistulae for dialysis access. J Vasc Access 2021; 22(4): 635-641. https://doi:10.1177/1129729820954725

20. Asrar A, Rafique Z, Afzal A, Nasim A, Talal A. Impact of Arteriovenous Fistula Creation on Progression of Chronic Kidney Disease. Pak J Med Health Sci 2022; 16(07): 127-127. https://doi.org/10.53350/pjmhs22167127

21. Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. Complications of the Arteriovenous Fistula: A Systematic Review. J Am Soc Nephrol 2017; 28(6): 1839-1850.

https://doi.org/10.1681/asn.2016040412