New probing and warm-wash-out technique improves early patency rates in arteriovenous fistula surgery

M. Kadan, G. Erol, K. Karabacak, E. Kaya, G. Özkan, S. Doğanci, V. Yildirim, U. Demirkiliç

Department of Cardiovascular Surgery, and Department of Cardiovascular Anesthesiology, Gulhane Military Academy of Medicine, Etlik, Ankara, Turkey. muratkadan@yahoo.com

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• Nephrology

OBJECTIVE: Arteriovenous fistulas (AVFs) are commonly used during hemodialysis. Early failure of AVFs is quite common with incidence of 43% to 63%. In this study we aimed to describe a novel approach to AVF surgery for improving early patency rates.

PATIENTS AND METHODS: Patients were divided into two groups according to use of probing and warm-wash-out technique. Group I consisted of 31 patients with additional probing technique. Group II consisted of 32 patients without additional maneuver. End-to-side anastomosis were used to all patients. Technical success was defined as having palpation of a thrill on fistula. Flow rates of draining vein was measured at 1st hour, 24th hour, 1st week and 3rd week of surgery. Surgical technique. Classical maneuvers were performed until end of the anastomosis. At this time, vein lumen was washed by low-dosed heparinized warm fluid, with assistance of a simple catheter.

RESULTS: Technical success was similar in both groups at 1st hour and 24th hour, while there were significantly differences between groups at 1st week (p = 0.042) and 3rd week (p = 0.05) assessments. Flow rates were also measured significantly higher in Group I at 1st hour (p = 0.011) and 24th hour (p = 0.016). Flow rates were almost similar in two groups at 1st and 3rd weeks but overall success rate was higher in Group I comparing with Group II (96.8% vs. 81.3%, respectively, p = 0.05).

CONCLUSIONS: Probing and warm-wash out technique will simply increase the surgical success and flow rate of draining vein.

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