The document discusses complications associated with arteriovenous fistulas (AVFs), highlighting an incidence rate of 20-27%. Key complications include bleeding, infection, thrombosis, non-maturation of the vein, and pseudoaneurysms, emphasizing that proper planning and technique can prevent many issues. It concludes that thorough vascular assessment and early diagnosis are essential to salvage AVFs and avoid loss.

1. DR KIRAN DAVE
MS,FRCS
VASCULAR AND ENDOVASCULAR SURGEON

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. COMPLICATION
 BLEEDING
 INFECTION
 THROMBOSIS
 NON MATURATION OF VEIN
 PSEUDOANEURYSM
 DISTAL ISCHEMIA
 VENOUS OEDEMA
 CARDIAC FAILURE
-

4. BLEEDING
 PRIMARY – SUTURE LINE BLEEDS – HAEMATOMA
– OCCLUSION OF FISTULA
 REACTIONARY – HYPERTENSION
 SECONDARY – INFECTION – NEEDS LIGATION OF
FISTULA

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

7. INFECTION
 INCIDENCE IS LOW
 USE OF PROPHYLACTIC ANTIBIOTICS
 DRESSING
 FISTULA CARE

8. 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

9. PSEUDOANEURYSM
 SWELLING AT SITE OF FISTULA
 PAIN
 CONFIRM ON DOPPLER
 RISK OF RUPTURE HIGH
 LIGATION OF FISTULA AND ARTERY
 MAY REQUIRE A VENOUS GRAFT

10. CARDIAC FAILURE
 OVER FUNCTIONING OF FISTULA
 PROXIMAL FISTULA
 LARGE ANASTOMOSIS
 REMEDY – CLOSURE OF FISTULA

12. 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

14. 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

16. COMPLICATION -SYNTHETIC GRAFT
 THROMBOSIS
 INFECTION
 PSEUDOANEURYMS
 REMOVAL OF GRAFT – INFECTION OR ANEURYSM

17. COMPICATION OF CV CATHETERS
 INFECTION – FEVER , RIGORS DURING DIALYSIS
 OCCLUSION – VENOUS THROMBOSIS
 DURING INSERTION – TRAUMA TO ARTERY AND
VEIN
 MIGRATION – FRACTURE OF CATHETER

18. CONCLUSION
 MANY A COMPLICATION LEADS TO LOSS OF
FISTULA
 PROPER VASCULAR ASSESSMENT BEFORE AVF
FORMATION IS MUST
 EARLY DIAGNOSIS AND INTERVENTION CAN
SALVAGE AVF

19. THANK YOU