Surgical Outcomes of Arteriovenous Fistula for Hemodialysis in End Stage Renal Disease Patients with Diabetes Mellitus

Abstract

Surgical Outcomes of Arteriovenous Fistula for Hemodialysis in End Stage Renal Disease Patients with Diabetes Mellitus

Chaiyaporn Suwitchakul MD

Department of Surgery, BMA General Hospital

Objectives: To study the patency rate and complications of arteriovenous fistula surgery for hemodialysis in end stage renal disease (ESRD) patients with diabetes mellitus. These outcomes were also compared between side-to-side and end-to-side anastomosis.

Study design: Descriptive study.

Subjects: A total of 101 ESRD patients with diabetes mellitus, who underwent arteriovenous fistula surgery for hemodialysis at the Department of Surgery, BMA General Hospital between January 2004 and June 2008.

Methods: Data were collected from out-patient and in-patient medical records including operative notes. Statistical analysis was performed.

Main outcome measures: Patency rate and complications.

Results: Mean age of the patients was 58.9 + 16.1 years. Duration of renal diseases before surgery was 13.6 + 7.1 months. Forty nine ESRD patients (48.5%) underwent autogenous arteriovenous fistula with side-to-side vascular anastomosis technique while 52 patients (51.5%) had an end to side technique. The most common complication was swelling of the operated arm (6.9%). Other complications were hematoma at surgical site (3.0%), surgical site infection (2.0%), and steal syndrome (2.0%). The patency rate at 1 and 5 years of all patients were 79.2% and 56.4%. Patients who had end to side technique was significantly younger than those who had side to side technique (55.5 + 16.8 vs 62.5 + 14.6 years). Mean operative time in end to side technique was significantly longer than side to side technique (60.0 + 12.1 vs 47.0 + 6.5 minutes). No significant difference of complications between the two groups was observed. The patency rates were also not significantly different between the two groups: 75.5% and 57.7% in side to side technique compared to 82.7% and 55.1% in end to side technique, at 1 year and 5 years respectively.

Conclusion: Arteriovenous fistula for end stage renal disease patients with diabetes mellitus has good outcomes. Patients who had end to side technique was significantly younger and had significantly longer mean operative time than those who had side to side technique. However; the patency rates and complications were not significantly different.

Keywords: arteriovenous fistula, diabetes mellitus, side to side anastomosis, end to side anastomosis

Vajira Med J 2010 ; 54 : 171-180