Outcome and complications of permanent hemodialysis vascular access in Nigerians: A single centre experience

Background: It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. Materials and Methods: The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patients clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. Results: One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. Conclusion: The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.