Native arteriovenous fistula, surgical outcomes and primary failure in Taiz Yemen: A prospective study

Author(s): Ismail S. Al-Shameri, Abduder A. Al-Ganadi, Naseem S. Al-Ossabi, Maha A. Hizam, TawfeeKA. Aatef, Samer S. Albothaigi

Background: Haemodialysis (HD) is a lifesaving and life-sustaining management for patients with End Stage Renal Disease (ESRD). There are number of vascular access options including native Arteriovenous Fistulas (AVF), artificial arteriovenous grafts (AVG) and dialysis catheters. AVF is generally recognized as the cornerstone of long-term dialysis treatment due to its superior patency and lower complication rates. The present study investigates surgical outcomes and complications post AVF creation by Parachute Vascular Anastomosis Technique (PVAT) in Taiz, Yemen.

Materials and methods: This prospective study of 196 patients who underwent a native AVF created by parachute anastomosis technique from October 2017 to September 2019 in Authority of Althawra hospital in Taiz- Yemen. Detailed physical examination (inflow arterial pulses and outflow veins) was performed. Patients with abnormal physical examination were sending for preoperative sonography mapping. Non-dominant upper extremity was used as priority site for vascular access creation. AVF was performed under local anesthesia. Patients were followed up in outpatient clinic for six months.

Result: Total of 231 AVF in 196 patients, 121 (61.7%) were male and 75 (38.3%) were female. Mean age was 48.5 ± 16.8 (range 9–85) years. A majority of AVF were brachiocephalic 112 (48.5%) while the remaining was radiocephalic 74 (32%) and brachiobasilic 43 (18.6%). Most of patients had left non-dominant upper arm AVF. The immediate patency rate (palpable thrill intra operative) was 218(94.4%) with an overall functional rate (successful use of the AVF for six consecutive sessions of HD) of 198 (85.7%). The primary failure rate (within 3 months) was 33 (14.3%). Six months primary patency was 186 (80%). During study period, the most common complication of AVF was thrombosis 30 (13%).

Conclusion: Based in our result and literature review we could report excellent functional rate (85.7%) of AVF created by parachute vascular anastomosis technique. For that, parachute technique may be suggested as one of optimal selection to create AVF especially in elderly, diabetic patients.