Arteriovenous shunting for hemodialysis

ABSTRACT

Two hundred and forty six shunts were done in the last 5 years as vascular access for haemodialysis in 205 patients with end stage renal failure. These included 203 radio-cephalic fistulae done at the region or just above it [121 end-to-side and 82 side-to-side], 2 saphenous loops, 4 polytetrafluoroethylene [PTFE] Impra grafts, 26 brachio-basilic, 10 external Scribner shunts and in one case a new technique of shunting the brachial artery to accompanying deep vein and 2 mouths later superficializing the vein so it can be used for haemodialyses. Most failures occur in the early post-operative period [within 48 hours] and usually due to inadequate outflow through the venous side which will cause thrombosis of the fistula. Other detected complications include aneurysm [2 cases], infection [11 cases], later graft thrombosis [3 cases], secondary haemorrhage [1 case], oedema and swelling of the hand [2 cases]. Satisfactory patency rates are obtained so long as the fistula is handled well in the early usage by the nephrology staff. The arteriovenous fistulae had been repeated in 39 cases