Hemodialysis arteriovenous fistula-related complications and surgery in kidney graft recipients

Abstract

Arteriovenous fistula (AVF) remains functional after kidney transplantation in many patients. The aim of this historical cohort study was to evaluate the data on AVF-related complications and surgery performed after kidney transplantation in our patients. The study cohort included the recipients of a kidney transplant with AVF complications between January 2006 and April 2012. 74 renal transplant recipients (47% male, mean age 51 ± 10, range 14 to 73 years) with complications related to AVF were analyzed. Among all AVFs, 51 (72%) were located in the forearm, nine (13%) in the upper arm, and 14 (15%) in the elbow. Complications occurred in 12.5% (74/592) of kidney graft recipients who were treated at our Outpatient Transplant Unit during the study period. The most common complication was painful thrombosis with or without thrombophlebitis, which occurred in 32 patients (43.2%). Other complications included growing aneurysms (27%, 20/74), venous hypertension with arm edema (8.1%, 6/74), distal hypoperfusion (8.1%, 6/74), high flow AVF with cardiac failure (8.1%, 6/74), trauma (1.3%, 1/74), and cosmetic appearance (4%, 3/74). Fifty-one surgical interventions were performed in 49 patients (mean age 52 ± 12, range 28 to 73 years). AVF closure was performed in 29/51 (56%) patients. Furthermore, an extirpation of aneurysm was performed in 12/51 (23%) and an extirpation of thrombosed AVF was performed in 1/51 (2%) patients, simple trombectomies were performed in 5/51 (10%) and a thrombectomy with reanastomosis was performed in 4/51 (8%) patients. One patient underwent percutaneous transluminal angioplasty for underlying stenosis after surgery. The most common AVF-related complications in kidney graft recipients are painful thrombosis (often accompanied with thrombophlebitis) and growing aneurysms. Surgical intervention is performed in a significant proportion of patients, mainly AVF closure, aneurysm extirpation, and thrombectomy.

Keywords: Arteriovenous fistula; Complications; Hemodialysis; Kidney transplantation.