MANAGEMENT OF COMPLICATIONS OF ARTERIOVENOUS FISTULA FOR HEMODIALYSIS

Abstract

Haemodiaysis is not a complete substitute for native renal function. It only provides bridge between ESRD and transplantation, in order to maintain and improve the patient's physical condition, thus ensuring the best possible outcome after renal transplantation. Haemodialysis patients depend on functional vascular access that is characterized by a superficial, low resistance, high flow conduit that allows for repetitive cannulation of the blood stream. Arteriovenous fistula maturation occurs through serial changes that occur at a hemodynamic, anatomic, molecular and functional level after the creation of the fistula. The single most important determinant of all is the response of both the feeding artery and the draining vein to the increase in shear stress that occurs after the creation of the arteriovenous fistula. Although the arteriovenous fistula usually provides satisfactory long term access for dialysis, complications may occur frequently. The most frequent complication leading to Summary and Conclusion 126 failure of the vascular access site is thrombosis. Many late complications such as venous hypertension, aneurysm, hemorrhage, vascular steal syndrome and stenosis may occur following AVF surgery. These may cause dysfunction of the AVF and limit the efficiency of haemodialysis. Color Doppler examination findings were considered abnormal in cases of greater than 50% stenosis of the feeding artery or outflow vein or in cases of decreased flow rate or increased resistance index in the brachial artery. A diagnostic angiogram is usually performed to evaluate the fistula in its entirety. Digital subtraction angiography (DSA) is invasive, but a major advantage over the other imaging modalities is the possibility of performing the endovascular intervention immediately.