Complications of Arteriovenous Fistula Surgery: A Comprehensive Study in Bangladesh

Abstract

Background: Arteriovenous fistula (AVF) surgery is vital for hemodialysis in patients with end-stage renal disease (ESRD). Despite its advantages over other vascular access methods, AVF surgery is associated with several complications, impacting patient outcomes. Objective: This study aims to investigate the complications associated with AVF surgery in Bangladesh, focusing on patient outcomes and contributing factors. Method: A comprehensive study was conducted at Rajshahi Diabetic Association Hospital and Rajshahi Apollo Hospital, Rajshahi, Bangladesh, from January 2020 to December 2023. A total of 1,288 patients underwent AVF surgery of these, 1,224 fistulas were created using the radial arteries and 64 using the brachial artery. Data were collected on postoperative complications, including fistula maturation failure, infections, thrombosis, and Aneurysms. Results: A total of 1,288 patients underwent AVF surgery, with 61% male (786) and 39% female (502) and a mean age of 42.3 years. The most common comorbidities were diabetes (45%, n=580) and hypertension (58%, n=746). Of the AVFs created, 95% (n=1,224) used radial arteries, and 5% (n=64) used the brachial artery. Overall, 28% (n=361) of patients experienced complications, including maturation failure (28%, n=361, p=0.03), Infections (5%, n=18, p=0.04), Thrombosis (13%, n=47, p=0.05), Aneurysms (9%, n=32, p=0.003) and post-operative oedema (1%, n=4, p=0.02). Complications were more frequent in AVFs created with the brachial artery and in patients with diabetes and hypertension, highlighting the need for improved preoperative and postoperative care. Conclusion: AVF surgery, while essential for hemodialysis, presents significant complications that can impact patient outcomes.