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Av access complications

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AV FISTULA A PROCEDURE FOR HAEMODIALYSIS HAS MANY COMPLICATIONS AND LEADS TO FAILURE OF FISTULA AND NEED FOR NEW SITE

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Av access complications

  1. 1. DR KIRAN DAVE MS,FRCS VASCULAR AND ENDOVASCULAR SURGEON
  2. 2. COMPLICATION  AVF IS CONSIDERED A MINOR PROCEDURE  INCIDENCE OF COMPLICATION- 20 -27%  MANY A COMPLICATION LEADS TO FAILURE OF FISTULA  LOSS OF SITE AND VEIN FOR FURTHER USE  CAN BE AVOIDED BY PLANNING ,TECHNIQUE AND PROPER USE OF FISTULA
  3. 3. COMPLICATION  BLEEDING  INFECTION  THROMBOSIS  NON MATURATION OF VEIN  PSEUDOANEURYSM  DISTAL ISCHEMIA  VENOUS OEDEMA  CARDIAC FAILURE -
  4. 4. BLEEDING  PRIMARY – SUTURE LINE BLEEDS – HAEMATOMA – OCCLUSION OF FISTULA  REACTIONARY – HYPERTENSION  SECONDARY – INFECTION – NEEDS LIGATION OF FISTULA
  5. 5. THROMBOSIS  EARLY – WITH IN 48 HRS – OCCLUSION OF FISTULA ( HYPERCOAGUBLE STATE, HYPOTENSION, HAEMATOMA, POOR VEIN CALIBRE, DISTAL THROMBOSIS)  LATE – SAME AS ABOVE , PUNCTURE SITE INTIMAL HYPERPLASIA , HAEMATOMA , SEPSIS ,HYPOTENSION
  6. 6. INFECTION  INCIDENCE IS LOW  USE OF PROPHYLACTIC ANTIBIOTICS  DRESSING  FISTULA CARE
  7. 7. NON MATURATION OF FISTULA  INCIDENCE OF UPTO 27 %  POOR VEIN CALIBRE  PREVIOUS PHLEBITIS  CALCIFIED ARTERIES  COMMON IN DIABETICS  IMPROPER SURGERY  REMEDY- NEW SITE / NEW FISTULA
  8. 8. PSEUDOANEURYSM  SWELLING AT SITE OF FISTULA  PAIN  CONFIRM ON DOPPLER  RISK OF RUPTURE HIGH  LIGATION OF FISTULA AND ARTERY  MAY REQUIRE A VENOUS GRAFT
  9. 9. CARDIAC FAILURE  OVER FUNCTIONING OF FISTULA  PROXIMAL FISTULA  LARGE ANASTOMOSIS  REMEDY – CLOSURE OF FISTULA
  10. 10. DISTAL ISCHEMIC SYMPTOMS  ALLENS TEST IS MUST – TO CHECK PATENCY OF PALMAR ARCH  COMMON IN BRACHIAL FISTULAS  INCIDENCE – 4%  EARLY DIAGNOSIS AND CORRECTION OF INFLOW- ARTERIAL THROMBOSIS  STEAL SYNDROME – NARROWING OF FISTULA OR LIGATION
  11. 11. VENOUS OEDEMA  COMMON IN SIDE TO SIDE FISTULA  VENOUS OUTFLOW OBSTUCTION  CORRECTION OF VENOUS OBSTRUCTION – VENOGRAPHY-PLASTY – SALVAGE FISTULA  ASSESSMENT OF VENOUS ANATOMY BY DOPPLER  USE THE SITE OPP TO CENTRAL VENOUS ACCESS
  12. 12. COMPLICATION -SYNTHETIC GRAFT  THROMBOSIS  INFECTION  PSEUDOANEURYMS  REMOVAL OF GRAFT – INFECTION OR ANEURYSM
  13. 13. COMPICATION OF CV CATHETERS  INFECTION – FEVER , RIGORS DURING DIALYSIS  OCCLUSION – VENOUS THROMBOSIS  DURING INSERTION – TRAUMA TO ARTERY AND VEIN  MIGRATION – FRACTURE OF CATHETER
  14. 14. CONCLUSION  MANY A COMPLICATION LEADS TO LOSS OF FISTULA  PROPER VASCULAR ASSESSMENT BEFORE AVF FORMATION IS MUST  EARLY DIAGNOSIS AND INTERVENTION CAN SALVAGE AVF
  15. 15. THANK YOU

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