AV FISTULA A PROCEDURE FOR HAEMODIALYSIS HAS MANY COMPLICATIONS AND LEADS TO FAILURE OF FISTULA AND NEED FOR NEW SITE

1. DR KIRAN DAVE
MS,FRCS
VASCULAR AND ENDOVASCULAR SURGEON

2. COMPLICATION
 AVF IS CONSIDERED A MINOR PROCEDURE
 INCIDENCE OF COMPLICATION- 20 -27%
 MANY A COMPLICATION LEADS TO FAILURE OF
FISTULA
 LOSS OF SITE AND VEIN FOR FURTHER USE
 CAN BE AVOIDED BY PLANNING ,TECHNIQUE
AND PROPER USE OF FISTULA

3. COMPLICATION
 BLEEDING
 INFECTION
 THROMBOSIS
 NON MATURATION OF VEIN
 PSEUDOANEURYSM
 DISTAL ISCHEMIA
 VENOUS OEDEMA
 CARDIAC FAILURE
-

4. BLEEDING
 PRIMARY – SUTURE LINE BLEEDS – HAEMATOMA
– OCCLUSION OF FISTULA
 REACTIONARY – HYPERTENSION
 SECONDARY – INFECTION – NEEDS LIGATION OF
FISTULA

5. THROMBOSIS
 EARLY – WITH IN 48 HRS – OCCLUSION OF
FISTULA ( HYPERCOAGUBLE STATE,
HYPOTENSION, HAEMATOMA, POOR VEIN
CALIBRE, DISTAL THROMBOSIS)
 LATE – SAME AS ABOVE , PUNCTURE SITE
INTIMAL HYPERPLASIA , HAEMATOMA , SEPSIS
,HYPOTENSION

7. INFECTION
 INCIDENCE IS LOW
 USE OF PROPHYLACTIC ANTIBIOTICS
 DRESSING
 FISTULA CARE

8. NON MATURATION OF FISTULA
 INCIDENCE OF UPTO 27 %
 POOR VEIN CALIBRE
 PREVIOUS PHLEBITIS
 CALCIFIED ARTERIES
 COMMON IN DIABETICS
 IMPROPER SURGERY
 REMEDY- NEW SITE / NEW FISTULA

9. PSEUDOANEURYSM
 SWELLING AT SITE OF FISTULA
 PAIN
 CONFIRM ON DOPPLER
 RISK OF RUPTURE HIGH
 LIGATION OF FISTULA AND ARTERY
 MAY REQUIRE A VENOUS GRAFT

10. CARDIAC FAILURE
 OVER FUNCTIONING OF FISTULA
 PROXIMAL FISTULA
 LARGE ANASTOMOSIS
 REMEDY – CLOSURE OF FISTULA

12. DISTAL ISCHEMIC SYMPTOMS
 ALLENS TEST IS MUST – TO CHECK PATENCY OF
PALMAR ARCH
 COMMON IN BRACHIAL FISTULAS
 INCIDENCE – 4%
 EARLY DIAGNOSIS AND CORRECTION OF
INFLOW- ARTERIAL THROMBOSIS
 STEAL SYNDROME – NARROWING OF FISTULA OR
LIGATION

14. VENOUS OEDEMA
 COMMON IN SIDE TO SIDE FISTULA
 VENOUS OUTFLOW OBSTUCTION
 CORRECTION OF VENOUS OBSTRUCTION –
VENOGRAPHY-PLASTY – SALVAGE FISTULA
 ASSESSMENT OF VENOUS ANATOMY BY DOPPLER
 USE THE SITE OPP TO CENTRAL VENOUS ACCESS

16. COMPLICATION -SYNTHETIC GRAFT
 THROMBOSIS
 INFECTION
 PSEUDOANEURYMS
 REMOVAL OF GRAFT – INFECTION OR ANEURYSM

17. COMPICATION OF CV CATHETERS
 INFECTION – FEVER , RIGORS DURING DIALYSIS
 OCCLUSION – VENOUS THROMBOSIS
 DURING INSERTION – TRAUMA TO ARTERY AND
VEIN
 MIGRATION – FRACTURE OF CATHETER

18. CONCLUSION
 MANY A COMPLICATION LEADS TO LOSS OF
FISTULA
 PROPER VASCULAR ASSESSMENT BEFORE AVF
FORMATION IS MUST
 EARLY DIAGNOSIS AND INTERVENTION CAN
SALVAGE AVF

19. THANK YOU