AV ACCESSCOMPLICATION

DR KIRAN DAVEMS,FRCS

VASCULAR AND ENDOVASCULAR SURGEON

COMPLICATIONAVF IS CONSIDERED A MINOR

PROCEDUREINCIDENCE OF COMPLICATION- 20 -27%MANY A COMPLICATION LEADS TO

FAILURE OF FISTULALOSS OF SITE AND VEIN FOR FURTHER

USECAN BE AVOIDED BY

PLANNING ,TECHNIQUE AND PROPER USE OF FISTULA

COMPLICATIONBLEEDING INFECTIONTHROMBOSISNON MATURATION OF VEINPSEUDOANEURYSMDISTAL ISCHEMIAVENOUS OEDEMACARDIAC FAILURE

-

BLEEDINGPRIMARY – SUTURE LINE BLEEDS –

HAEMATOMA – OCCLUSION OF FISTULAREACTIONARY – HYPERTENSION SECONDARY – INFECTION – NEEDS

LIGATION OF FISTULA

THROMBOSISEARLY – WITH IN 48 HRS – OCCLUSION OF

FISTULA ( HYPERCOAGUBLE STATE, HYPOTENSION, HAEMATOMA, POOR VEIN CALIBRE, DISTAL THROMBOSIS)

LATE – SAME AS ABOVE , PUNCTURE SITE INTIMAL HYPERPLASIA , HAEMATOMA , SEPSIS ,HYPOTENSION

INFECTIONINCIDENCE IS LOW USE OF PROPHYLACTIC ANTIBIOTICSDRESSINGFISTULA CARE

NON MATURATION OF FISTULAINCIDENCE OF UPTO 27 % POOR VEIN CALIBREPREVIOUS PHLEBITISCALCIFIED ARTERIESCOMMON IN DIABETICSIMPROPER SURGERY

REMEDY- NEW SITE / NEW FISTULA

PSEUDOANEURYSMSWELLING AT SITE OF FISTULAPAIN CONFIRM ON DOPPLERRISK OF RUPTURE HIGHLIGATION OF FISTULA AND ARTERY MAY REQUIRE A VENOUS GRAFT

CARDIAC FAILUREOVER FUNCTIONING OF FISTULAPROXIMAL FISTULALARGE ANASTOMOSIS

REMEDY – CLOSURE OF FISTULA

DISTAL ISCHEMIC SYMPTOMSALLENS TEST IS MUST – TO CHECK

PATENCY OF PALMAR ARCHCOMMON IN BRACHIAL FISTULASINCIDENCE – 4%EARLY DIAGNOSIS AND CORRECTION OF

INFLOW- ARTERIAL THROMBOSISSTEAL SYNDROME – NARROWING OF

FISTULA OR LIGATION

VENOUS OEDEMACOMMON IN SIDE TO SIDE FISTULAVENOUS OUTFLOW OBSTUCTIONCORRECTION OF VENOUS OBSTRUCTION –

VENOGRAPHY-PLASTY – SALVAGE FISTULAASSESSMENT OF VENOUS ANATOMY BY

DOPPLERUSE THE SITE OPP TO CENTRAL VENOUS

ACCESS

COMPLICATION -SYNTHETIC GRAFTTHROMBOSISINFECTIONPSEUDOANEURYMS

REMOVAL OF GRAFT – INFECTION OR ANEURYSM

COMPICATION OF CV CATHETERSINFECTION – FEVER , RIGORS DURING

DIALYSISOCCLUSION – VENOUS THROMBOSISDURING INSERTION – TRAUMA TO

ARTERY AND VEINMIGRATION – FRACTURE OF CATHETER

CONCLUSIONMANY A COMPLICATION LEADS TO LOSS

OF FISTULAPROPER VASCULAR ASSESSMENT BEFORE

AVF FORMATION IS MUSTEARLY DIAGNOSIS AND INTERVENTION

CAN SALVAGE AVF

THANK YOU