Responsible factors for fistula failure in end stage renal disease

Background: multiple factors are responsible for failure of arterio venous fistula (avf) in end stage renal disease patients. that require maintenance hemodialysis. out of technical errors,site of insertion,hypotension,size of vessels,diabetes and atherosclerosis are the common causes of failures in avfs. aim: to determine the causes of failure of arteriovenous fistula in end stage renal failure patients. patients and methods: this study was carried out at department of nephrology,sandeman provincial hospital/bolan medical college,quetta. forty cases of end stage renal disease (esrd) patients were referred for avf during january 2007 to december 2009. they were selected and operated upon avf by a given surgeon with a technique (end-to-side or side to side) and followed for two years regularly. in addition to under lying disease such as diabetes mellitus,atherosclerosis and inappropriate vessels,another factors such as hypotension and bleeding of aneurismal vessels were recorded when avf failed. results: four out 44 patients were excluded from this study because of impossible insertion of avf due to severe damage and thrombosis of peripheral vessels. fifty (50) avfs were inserted in 40 patients,28 in snuff box of left hand,11 in distal of left fore arm,9 nine cases in left arm and 2 in snuff box of right hand,28% failed primarily (before dialysis) commonly due to drop in blood pressure and among the remaining 72%,44% patient had functional avf for at least 24 month and 28% of them 6.0 months functioned for then failed monthly due to hypotension during heamodialysis. conclusion: hypotension was the cardinal cause of failure of avfs in esrd patients. we can reduce failure rate by monitoring and controlling the blood pressure during heamodialysis and prevent hypotension by salted regimen intake.