Clinical aspects and Outcome of Vascular Access Surgery in End stage Renal Disease
The study was done to access the outcome of the factors affecting Atrio-Venous Fistula procedure in Indian subjects. A prospective study based on evaluation for construction of Atrio-Venous Fistula for haemodialysis in Indian patients of ESRD was carried out. Pre-operative assessment of both arterial and venous components by physical examination and by CDFI was done and feasibility of construction of AVF was based on the same. Studies on Western subjects have shown the success of AVF with vein diameter more than 2.5mm and arterial diameter more than 2mm plus AVF has maximal flow if the Fistula if the Fistula diameter is 75% more than the diameter of the artery. In this study we incorporated similar guidelines ,however AV Fistulas were constructed even if caliber of vessels were lesser than the above mentioned caliber ,it is a known fact that that Europeans and Western subjects have larger caliber blood vessels as compared to Indian subjects. Of all the radio-cephalic AVF the diameter of radial artery was more than 02 mm, .range 2.1mm-2.5mm and however cephalic vein diameter was less than 2.5mm,range 1.0-2.3mm and in brachio-cephalic AVF the diameter of brachial artery was > 2mm,range 3.7-6.0mm and cephalic vein diameter >2.5mm,range3.9-4.1mm. After one year follow up 38 AVF were functional(01 underwent renal transplant) and 12 AVF were non-functional. The AVF should be constructed even if the vein diameter is less than 2.5mm and arterial diameter is less than 2.0mm in Indian subject, as the patency was 75.6% after 01 year.