Background
Repeated access to the circulation is essential to perform adequate maintenance hemodialysis. Dysfunction of fistulas is the most common reason for secondary intervention and recurrent hospitalization.
Aim
The aim of this study was to report our experience regarding incidence, diagnosis, and different modalities of treatment of complications of arteriovenous fistula.
Patients and methods
This study was conducted prospectively on 239 end-stage renal disease patients who presented to the Department of Vascular Surgery of Assiut University Hospital with complicated arteriovenous (AV) accesses from January 2014 to January 2015. All patients underwent detailed history taking, and data were collected on age, sex, cardiovascular risk factors, history of previous accesses, and any complications that developed since the use of the access. Patients were further evaluated using clinical examination, duplex ultrasound, and fistulography if needed.
Results
There were 137 (42.7%) males and 102 (42.7%) females with a mean age of 57 ± 4 years. Hypertension was the risk factor in 103 (43.1%) patients, whereas diabetes mellitus was present in 45 patients. Of the 239 patients, 57 (23.8%) presented with infected AV access, 42 (17.6%) with thrombosed AV accesses, 33 (13.8%) with bleeding, and 31 (12.9%) with pseudoaneurysms. Venous hypertension was the presenting complication in 26 (10.9%) patients, whereas aneurysmal dilatation, hematoma, and ischemic steal were the presenting complications in 25 (10.5%), 20 (8.4%), and 5 (2.1%) patients, respectively.
Conclusion
Complications of hemodialysis access create significant problems for nephrologists and the healthcare system. Access interventions are often costly, challenging, and may require specialized surgical expertise. Management of complications associated with AV access is an integral part of planning individual hemoaccess procedures.