Complications of arteriovenous fistula for haemodialysis access

Abstract

Background: This study was conducted to determine the complications of arteriovenous fistulae created for haemodialysis access in Christian Medical College, Ludhiana. The complications were classified as early and late complications.Methods: This study was a one year retrospective and one year prospective study conducted in the Department of Surgery and Nephrology, Christian Medical College and Hospital, Ludhiana. After determination of the appropriate limb for surgery, arteriovenous fistulae were done under local anaesthesia in the operation theatre. All anastomosis was end (vein) to side (artery) and were done by using 6’0’ prolene. The fistula created was monitored for a good thrill, pulse, and any immediate complication such as bleeding or thrombosis. After four to six weeks, a fistula with a good thrill was considered to be mature and was subjected to cannulation and then haemodialysis. The fistula flow rate was recorded at initiation of haemodialysis and after four weeks of haemodialysis. A nine month follow up study was done, and the late complications of the fistulae were also noted.Results: Early complication was defined as complications arising within one month of creation of fistula, i.e. before maturation. The most common early complication was thrombus (8.5%). The second frequent complication was wound infection (3.4%). The most common late complication was thrombosis (18.6%). The second common late complication was pseudoaneurysm (4.23%). There was a statistically significant correlation between development of late complications with Diabetes Mellitus Type 2, Systemic Hypertension and history of I/V cannulation and IJV insertion in the study population (p value - 0.000).Conclusions: This study has thus demonstrated that the vascular unit of General Surgery in Christian Medical College, Ludhiana is making arteriovenous access for haemodialysis at a rate comparable to other centres in India and worldwide. The early and late complications were also similar to other data available in India.