Predictors for Failure to Mature of Autogenous Arteriovenous Fistulae: Alor Setar Experience

ABSTRACT

Renal replacement therapy in Malaysia has changed dramatically. In 1980 there were only 59 patients on dialysis. Since then the number of patients has increased exponentially from 4,540 in 1998 to almost 15,000 in 20061. Autogenous Arteriovenous Fistula (AVF) provides an excellent long term hemodialysis access with low rates of infection, thrombosis and is cost effective. Hospital Sultanah Bahiyah is a tertiary hospital situated in the northern region of Peninsular Malaysia. Vascular Access creation is one of the main services provided by our surgical unit; with an average of 100 patients seen in the vascular access clinic per month. The number of AVF operations has increased from 30 cases in 2001 to 328 in 2007. The reported rates of Primary Fistula Failure (fistula fail to mature) varies from 8% to 53%2,4. Immature fistulae will lead to prolonged dependence on dialysis catheters. This phenomenon is well known to be associated with the risk of infective complications, central venous thrombosis or stenosis and patients’ inconvenience. Numerous studies have reported the predictors of successful fistulae, but are varied in their design, definitions, end points and clinical factors considered 2,3 Preoperative imaging also has been proposed, but their widespread use is generally limited in most of the centres4. Knowing the risk factors for failure will help the surgeon to take the necessary precautions and preventive measures more effectively. The information may help to stratify the patients into various risk groups based on their likelihood to develop fistula failure. Thus, the main objective of this study was to identify clinical risk factors that are related to Failure to Mature (FTM) of autogenous AVF.