Effect of hydrostatic venous dilatation during creation of arterio-venous fistula on maturation of hemodialysis access

Abstract

Background : The objective of arteriovenous access creation is to furnish an available vascular structure with enough bloodstream that can be cannulated for satisfactory dialysis. Ultrasonographic assessment is considered a standard strategy for each medical procedure of arteriovenous fi stula (AVF) creation. It determines utilized AVF work monitoring in the postoperative period. Objective : To review and discuss the advances in the effect of hydrostatic venous dilatation during intraoperative AVF creation in end-stage renal disease patients and its effect on the maturation of the fi stula guided by preoperative and postoperative Duplex assessment. Patients and methods : This prospective study was performed on 40 patients presented in the Department of Vascular Surgery at Al-Azhar University hospitals (Al-Hussin and Bab-Alsheryah hospitals). Patients were monitored regularly in the dialysis unit; data collected included patient demographics, comorbidities, any previous vascular access, type of anatomical site of current AVF, details of the operative procedure, exact expected time, and functional maturation. Patient will do surgical AVF creation with estimated glomerular fi ltration rate less than 15.0 ml/min referred from nephrology department. Results : At 6 weeks postoperatively, the mean vein diameter was 6.4 mm at the site of anastomosis, 6.23 and 6.1 mm at 3 and 10 cm proximal to the site of anastomosis, respectively. The average vein diameter increased by 0.57 mm (15.5%) after hydrostatic dilatation and 3.23 (112.2%) after 6 weeks from intervention. Conclusion : The creation of effective AVF hemodialysis all together develop adequate hemodialysis and is in fl uenced by various factors, the most signi fi cant factor being distensibility of the vein through percent of the expansion in vein width not preoperative supreme vein measurement