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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 148-149
Arteriovenous shunt and its conversion to arteriovenous fistula: A relook


Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication8-Jan-2010
 

How to cite this article:
Gupta A, Khaira A, Bhowmik DM, Tiwari SC. Arteriovenous shunt and its conversion to arteriovenous fistula: A relook. Saudi J Kidney Dis Transpl 2010;21:148-9

How to cite this URL:
Gupta A, Khaira A, Bhowmik DM, Tiwari SC. Arteriovenous shunt and its conversion to arteriovenous fistula: A relook. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 May 29];21:148-9. Available from: http://www.sjkdt.org/text.asp?2010/21/1/148/58791
To the Editor,

Vascular access is a significant economic, sur­gical and logistical consideration for patients as well as health-care givers of patients with chronic kidney disease. Of the traditional tem­porary accesses, the subclavian catheters have gone into disrepute worldwide. In a country like India, where most often, nephrologists see the patient for the first time in CKD stage-5 or even stage-6 due to late referral, it becomes mandatory to initiate dialysis through a tempo­rary vascular access. [1] Even in the United States, 60% of the patients starting dialysis do so with a central catheter. [2] Majority of our patients are planned for a live related renal transplant and a temporary vascular access acts as a bridge. For those who choose maintenance hemodialysis as a long-term renal replacement modality, adequate time is available for an arteriovenous fistula to be created. We report herein our experience of fifteen end-stage re­nal failure patients who presented late to us without any vascular access. All of them underwent a distal radio-cephalic arteriovenous (AV) shunt surgery under local anesthesia, after clinical assessment of vessels for suita­bility. The AV shunt kit (Medionics) comprised of silicon cannula 2.6 mm internal diameter, vessel tips number 16 and 17 and a double beveled PTFE cannula connector, 38 mm long. The procedure was successful in all cases. Hemodialysis was initiated immediately after surgery. Six weeks of dialysis was carried out. One patient had local site infection after four weeks, which was treated with mupirocin oint­ment. None had bactremia, sepsis or throm­bosis. The AV shunts were electively con­verted after six weeks to mid-forearm arte­riovenous fistula (AVF) two cm proximal to the vessel tip. End of vein to side of artery was used and the AV shunt was removed. Bruit was noted immediately in all conversions. The mean time-interval to the use of AVF was 12 days after the conversion. The cases were followed-up for 12 weeks and only one had thrombosis of AVF two weeks after conversion.

The above report highlights the use of AV shunts in cases that are referred late, or re­quired dialysis acutely. By and large, catheter­associated bactremia, thrombosis and other mechanical complications of central catheters can be avoided. Further, the cosmetic pro­blems associated with the central catheters can be avoided.

We conclude from our preliminary analysis that AV shunts form a viable option as a bridge for patients with ESRD who present late before an AVF is created. The matured vessels provided by the AV shunts shorten the time for the first use of AVF. However, a small disadvantage was the use of femoral ca­therization from the period of AVF creation to its maturation. This technique, which was prac­ticed many years ago and has been replaced with the frequent use of central catheters, needs to be re-looked into.

 
   References Top

1.Tiwari SC, Bhowmik DM. Staging of CKD: is a new stage needed? Am J Kidney Dis 2002; 39:S1-266.  Back to cited text no. 1      
2.Pisoni RL, Young EW, Dykstra DM, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002;61:305-16.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Ankur Gupta
Department of Nephrology, All India Institute of Medical Sciences, New Delhi
India
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PMID: 20061711

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