• Muhammad Jamil
  • Rashid Usman
  • Kishwar Ali


Background: Patients with end stage renal disease need an accurate and effective vascular access for haemodialysis. This study was conducted to postulate a hypothesis that proximal arterio venous fistula (AVF) creation should be a gold standard in Chronic Renal Failure (CRF) patients with multiple co morbidities. Methods: A total of 230 patients reporting to Vascular Surgery Clinic in Combined Military Hospital Lahore and Peshawar from January 2014 to January 2016 for AVF creation, were included and equally divided into two groups by random draw method. Distal AVF created in Group A and proximal AVFs at elbow in Group B. The data regarding age, gender, atherosclerotic risk factors, body mass index (BMI) was recorded. The groups were compared for functional maturation of AVF and their patency at 6 and 12 months. Results:  Mean age was 30±SD 6.5 years (31±SD 5.1 in Group A, 30±SD 6.9 in Group B) with a male to female ratio of 5.4:1. In terms of age (p-value 0.529), gender (p-value 0.716), diabetes (p-value 0.682), hypertension (p-value 0.659) and BMI; there was no difference between two groups. 85.2% (n=98) AVFs matured in Group B as compared to 44.3% (n=51) AVFs in Group A (p-value=0.0045). Furthermore, statistically significant differences between the two groups were found in terms of patency rates at 6 and 12 months (73.9% and 66% in Group B: 26.9% and 16.5% in Group A; p-value 0.0039 and 0.0007 respectively). Conclusion: Proximal AVF creation in CRF patients with multiple co morbidities should be the gold standard as a primary procedure in terms of better long term primary patency.Keywords:  co morbidity; creation; Aold standard; proximal AVF


Rayner HC, Besarab A, Brown WW, Disney A, Saito A, Pisoni L. Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. Am J Kidney Dis 2004;44(5 Suppl 2):22–6.

Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venepuncture and a surgically created arteriovenous fistula. N Engl J Med 1966;275(20):1089–92.

D'Cunha T, Besarab A. Vascular access for hemodialysis: 2004 and beyond. Curr Opin Nephrol Hypertens 2004;13(6):623–9.

Monroy-Cuadros M, Yilmaz S, Salazar-Banuelos A, Doig C. Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol 2010;5(10):1787–92.

Chen HY, Chiu YL, Chuang YF, Hsu SP, Pai MF, Lai CF, et al. Association of low serum fetuin A levels with poor arteriovenous access patency in patients undergoing maintenance hemodialysis. Am J Kidney Dis 2010;56(4):720–7.

Miller E, Carlton D, Deierhoi MH, Redden DT, Allon M. Natural history of arteriovenous grafts in hemodialysis patients. Am J Kidney Dis 2000;36(1):68–74.

Huijbregts HJ, Bots ML, Wittens CH, Schrama CH, Moll FL, Blankestijn PJ. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008;3(3):714–9.

Schwab J, Besarab A, Beathard G. National Kidney Foundation DOQI clinical practice guidelines for Haemodialysis Vascular Access Working Group. Am J Kidney Dis 1997;30(4 Suppl 3):S154–91.

Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, et al. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003;63(1):323–30.

Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002;61(1):305–16.

Bellinghieri G, Ricciardi B, Costantino G, Torre F, Santoro D, Cimadoro D, et al. Exhaustion of vascular endowment in hemodialysis: proposal for a permanent inlet access. Int J Artif Organs 1998;21(4):201–4.

Rossi G, Rigamonti P, Ticha V, Zoffoli E, Giordano A, Gallieni M, et al. Percutaneous ultrasound-guided central venous catheters: the lateral in-plane technique for internal jugular vein access. J Vasc Access 2014;15(1):56–60.

Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48(Suppl 1):S176–247.

Stehman-Breen OO, Sherrard DJ, Gillen D, Caps M. Determinants of type and timing of initial permanent hemodialysis vascular access. Kidney Int 2000;57(2):639–45.

Mendes RR, Farber MA, Marston WA, Dinwiddie LC, Keagy BA, Burnham SJ. Prediction of wrist arteriovenous fistula maturation with preoperative vein mapping with ultrasonography. J Vasc Surg 2002;36(3):460–3.

Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 2006;17(11):3204–12.

Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 2004;28(6):583–9.

Lazarides MK, Georgiades GS, Antoniou, GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007;45(2):420–6.

Hodges TC, Fillinger MF, Zwolak RM, Walsh DB, Bech F, Cronenwett JL. Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg 1997;26(6):1009–19.

Ifudu O, Mayers JD, Cohen LS, Paul H, Brezsnyak WF, Avram MM, et al. Correlates of vascular access and nonvascular

access related hospitalizations in hemodialysis patients. Am J Nephrol 1996;16(2):118–23




Most read articles by the same author(s)

1 2 3 > >>