Creating an arteriovenous fistula in patients with chronic kidney disease stage 5

Aim. Comparative assessment of microsurgical and traditional methods for creating an arteriovenous fistula for long-term hemodialysis in patients with chronic renal failure.

Methods. Results of arteriovenous fistula surgeries for creating arteriovenous fistula for long-term hemodialysis in 169 patients with chronic renal failure in the period from 2008 to 2013 were analyzed. The main group included 87 patients in whom arteriovenous fistula was formed by microsurgery. For fistula thrombosis prophylaxis, 40 mg of nadroparin calcium (fraxiparine) was used in this group after surgery as a postoperative bolus, followed by 7 days subcutaneous administration. Arteriovenous fistula in patients of the main group underwent anti-thrombogenic treatment: paravasal tissues and vessel outside were irrigated by 1% sodium chloride methylthioninium (methylene blue) after the main phase of the operation, followed by lysine acetylsalicylate standard solution after 2 minutes. The control group included 82 patients in whom fistula was created conventionally without using microsurgical techniques. For arteriovenous fistula thrombosis prevention, 5000 IU of sodium heparin was used 4 times a day in patients of the control group.

Results. In the main group, five cases of fistula thrombosis were observed in patients with diabetes mellitus and two in patients with chronic glomerulonephritis. In the control group, arteriovenous fistula thrombosis in the early postoperative period was recorded in 13 patients with diabetes mellitus, in four - with chronic glomerulonephritis, and in one - with polycystic kidney disease. In one (1.15%) patient of the main group and in three (3.66%) in the control group, wound infection associated with inflammatory processes development at the surgical wound was noted.

Conclusion. Microsurgical formation of arteriovenous fistula in patients with terminal stage of chronic kidney disease is the method of choice (especially with concomitant diabetes mellitus), allowing to significantly reduce the risk for arteriovenous fistula thrombosis and therefore reduce the number of unsatisfactory results.