LETTER TO THE EDITOR
Year : 2010 | Volume
: 21 | Issue : 1 | Page : 148--149
Arteriovenous shunt and its conversion to arteriovenous fistula: A relook
Ankur Gupta, Ambar Khaira, Dipankar M Bhowmik, Suresh C Tiwari
Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
Department of Nephrology, All India Institute of Medical Sciences, New Delhi
|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;21:148-149
|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 2021 Sep 28 ];21:148-149
Available from: https://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.  Even in the United States, 60% of the patients starting dialysis do so with a central catheter.  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.
|1||Tiwari SC, Bhowmik DM. Staging of CKD: is a new stage needed? Am J Kidney Dis 2002; 39:S1-266.|
|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.|