DOI: https://doi.org/10.53350/pjmhs22164713 ORIGINAL ARTICLE P J M H S Vol. 16, No. 04, APR 2022 713 Clinical Characteristics and Outcome of Arteriovenous Fistula among Patients Undergoing Haemodialysis with end Stage Renal Disease FARHAN KHAN 1 , NAVEED SOOMRO 2 , IFTIKHAR AHMED 3 , SHAFIQUE UR REHMAN 4 , USMAN QAMAR 5 , ZULFIKAR AHMED 6 1,2,3 Senior Registrar, Department of urology, Bilawal medical college for boys, LUMHS Jamshoro 4 Professor, Department of urology, Bilawal medical college for boys, LUMHS Jamshoro 5 Assistant Professor, Department of urology, Sindh Institute of Urology and Transplantation Karachi 6 Assistant professor in urology and renal transplant department Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Gambat Corresponding author: Farhan Khan, Email: drkhanfarhan@ymail.com ABSTRACT Objective: To determine the clinical characteristics and failure rate of arteriovenous fistula (AVF) among patients undergoing haemodialysis with end stage renal disease. Methodology: This was a cross-sectional study, done at department of urology at Bilawal Medical College for Boys, Liaquat University of Medial and Health Sciences Jamshoro Pakistan, with time duration of eleven months from April 2021 to February 2022. All the patients with age of more than 20 years, both genders, end stage renal disease and undergoing haemodialysis were included. The optimal site for fistula development was determined after taking blood pressure and completing the Allen test. Vascular diameter, intravascular thrombosis, arterial wall atherosclerosis, and the opening of arterial inflow and venous outflow access were all assessed during the procedure. End- to- side and side-to-side arteriovenous fistula were established if there were no contraindication. The patients were discharged after establishing the fistula's patency and experiencing the thrill. The patient's fistula patency and hemodialysis performance were assessed till six weeks. All the information was documented in the self-made proforma. SPSS version 26 was used for the data analysis. Results: A total of 100 cases were studied, most of the cases (49.0%) were more than 50 years old and males were most common 71.0%. Out of all, 59(59.0%) cases were diabetics and hypertensive. According to the site of arteriovenous fistulae (AVF), Left radio cephalic AVF was31.0%, left brachio cephalic AVF was 40.0%, left brachio basilic AVF 24.0%, right radio cephalic AVF 03.0%, right Brachio cephalic AVF 1.0% and right brachio basilic AVF 1.0%. At 6 th week follow-up arteriovenous fistula was observed successfully functional in 91.0% cases, while 5.0% arteriovenous fistula were burst and in 3.0% it was failed, while one patient was died during this six-weeks follow-up. Conclusion: For haemodialysis, the arteriovenous fistula was observed to be the best and preferable option with higher functioning rate, noninvasive and lower complicated. Keywords: Renal failure, AVF, function, failure INTRODUCTION Throughout the last twenty years, chronic kidney disease (CKD) has been on the rise. It is one of the hazardous illnesses, with significant psychosocial and economic consequences. 1 In the current worldwide burden of chronic kidney disease, developing nations, including Pakistan, are facing a silent pandemic of end stage renal disease (ESRD). 2,3 Haemodialysis, peritoneal dialysis, and kidney transplantation are among the treatments available. 1 Centers of the renal transplantation are limited to the disproportionately increasing ESRD patients. As a result, hemodialysis is still a promising therapeutic approach. Long-term hemodialysis survival is often poor, according to global data. 2,4 Non-tunneled and tunneled catheters, arteriovenous grafts (AVGs), and arteriovenous fistulas are all used to provide hemodialysis. The introduction of hemodialysis in the mid-twentieth century created a demand for dependable, repeatable circulation access. 5 In 1966, a seminal paper describing hemodialysis via an autologous arteriovenous fistula (AVF), significantly minimizing the problems of infection and thrombosis that plagued previously known long-term cannulation methods and external shunts. 5 Autologous AVF has since been widely accepted as the best hemodialysis access method, with lower morbidity and mortality rates and lower maintenance costs. 5 Despite being the finest dialysis access, the fistula is sensitive to a number of consequences, including lower blood flow, infection, aneurysm, thrombosis, hand edema and ischemia, and cardiac overload. 6 The use of adequate care can help to avert these consequences. The healthcare team and the chronic renal patients share responsibility for the measures in this procedure, and the chronic kidney patient must be taught in self-care about preparing and creation of a cannulation, as well as administration of his new VA. 6,7 Age, renal dysfunction pathology, severity of renal dysfunction and likelihood of cure, hydration and blood pressure, comorbid diseases and complications occurrence, arm vessels status, the immediate response of starting dialysis, and average lifespan all play a role in determining the vascular access method and access site. 8,9 Surgical procedure types used, hypertension, hand and finger workouts, and selective occlusion of main venous branches are all factors that influence the fistula maturation. 8 This study has been conducted to assess the clinical characteristics and failure rate of arteriovenous fistula among patients undergoing haemodialysis with end stage renal disease. MATERIAL AND METHODS This was a cross-sectional study, which was done at department of urology at Bilawal Medical College for Boys, Liaquat University of Medial and Health Sciences Jamshoro Pakistan. Study was done during a period of eleven months from April 2021 to February 2022. All the patients with age of more than 20 years, both genders, end stage renal disease and undergoing haemodialysis were included. Patients having other sever comorbidities, intensive care unit (ICU) admitted patients, patients who did not come in follow-up, and those who were not agree to participate in the study were excluded. After taking demographic medical history and verbal informed consent, complete clinical examination and all the required laboratory investigations were done. The optimal site for fistula development was determined after taking blood pressure and completing the Allen test. Vascular diameter, intravascular thrombosis, arterial wall atherosclerosis, and the opening of arterial inflow and venous outflow access were all assessed during the procedure. End- to- side and side-to-side arteriovenous fistula was established if there was no contraindication. Any patient who did not match the above criteria was ruled out of the research. Our team completed all operations satisfactorily. The patient was discharged after establishing the fistula's patency and experiencing the thrill. The patient's fistula patency was assessed on the first day, the first week, and hemodialysis performance after the sixth week. All the information regarding age, gender, comorbidities, causes of renal failure, site of arteriovenous Fistulae and outcome of AVFs in terms of success and failure were documented in the self-made proforma. SPSS version 26 was used for the data analysis.