A Study of Vascular Surgical outcomes in hemodialysis Access.

INTRODUCTION : Vascular Access continues to be a leading cause for hospitalization and morbidity in patients with chronic kidney disease stage 5. An ideal access delivers a flow rate to the Dialyzer adequate for the dialysis prescription, has a large use – life and has a low rate of complications. Studies over several decades consistently demonstrate that native fistula accesses have the best 4 to 5 years patency rates and require the fewest interventions compared with other access type. The present study acknowledges the importance of increasing the number of fistulae in use, but believes that emphasis should be shifted from the fistula construction rate to the rate of usable fistula accesses. This study also detects vascular accesses at risk complication rates and to implement procedures that maximize access longevity. AIM : To study the effect of preoperative duplex mapping on vascular access in hemodialysis patient. To compare the outcome of A.V. Access in patients who were assessed pre-operatively by clinical method versus patients who were assessed pre-operatively both by clinical and duplex scan To study the early patency and early failure rates. To study the reasons for Early failure rates and the complications in A.V. Access. To evaluate the minor modifications in the operative technique to improve the outcome of AV Access. To study the correlation between early postoperative flow rate, vein size and patency based on duplex scan. 48 CONCLUSION : 1) Analyzing the effect of preoperative duplex mapping for Arterial and Venous System: The preference of Arterial and Venous Segment is determined and The failure rates in A.V. Access surgery is decreased. 2) Comparing the outcomes of A.V. Access surgery done based on clinical versus clinical and duplex method, the failure rates inclinical method – 17% failure 14/82 and 10% failure 6/60 in Duplex • The Duplex method seemed to have less failure with statistical significance of P<.001. 3) Studying the failure group, the paediatric and Adult females have more number of failures. • The pediatric population had failures and are statistically significant (11/21 Vs 9/121 – P< .05) 4) The reasons for early failure rates are analyzed and the causes, like, Technical problem at Anastomosis, Hypotension and early spasm contributes 23.5% each. 5) In evaluating the minor modifications in the operative technique, like End to side perpendicular anastomosis, only a small group 23 cases out of 142 are operated and statistical significance not established. The effective use of Basilic vein for AV fistula creation and transposition surgery is a good alternative to synthetic graft. Such procedures are done only in a small group in our study. 6) Studying the early postoperative veinsize and flow rates based on duplex scan, the increase in vein size and flow rates achieved at the end of IV week. However the flow rate and vein diameter measurement by duplex scan is operator dependent and subject to error in cross section area and angle of insonation. 7) In this study, the risk group, which requires definite preoperative duplex mapping are identified. They are – Pediatric Patients, Female patients, Patients with H/o Central Venous Catheterization, Primary procedure failure patients.