Abstract: SA-PO956
Arteriovenous Shunt for Hemodialysis – A Viable and Cost-Effective Vascular Access Option in Hemodialysis Patients
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Bhalla, Anil, Sir Ganga Ram Hospital , New Delhi, New Delhi, India
- Gupta, Ashwani, Sir Ganga Ram Hospital , New Delhi, New Delhi, India
- Gupta, Anurag, Sir Ganga Ram Hospital , New Delhi, New Delhi, India
- Bhargava, Vinant, Sir Ganga Ram Hospital , New Delhi, New Delhi, India
- Rana, Devinder S., Sir Ganga Ram Hospital , New Delhi, New Delhi, India
Background
In India, the most common vascular access for HD(95%) is Arteriovenous fistula (AVF). Primary AVF is the most preferred permanent vascular access - which can be created by radiocephalic or brachiocephalic anastomosis. Ageing population and diabetic patients presenting with sub-optimal veins, along with the issue of late referral makes timely AVF creation an unmet goal. Managing associated complications is an indispensable part of patient care but is also responsible for drain of fiscal resources.
Methods
We started hemodialysis programme in the Dept. of Nephrology, Sir Ganga Ram Hospital in 1981. Due to late referral and immediate need of dialysis, AV shunts were created. In patient with AKI, this shunt could be removed after recovery. In ESRD patients, the same shunt could be converted into AV fistula. Thus, a fistula created after maturation of veins following shunt placement could be used as early as 1-2 weeks. Since its inception, at our centre, vascular access creation has been in the domain of nephrologists.
Results
We have created 2640 AV Shunts till 2014 with infection rates <5% and 3-month shunt blockage <10%. In view of logistic reasons, due to non-availability of shunt material, the programme suffered a setback. We continued to re-use shunts after sterilization, but, they are no longer available now. We have created 7920 AV Fistulas since 1981 till December 2017–achieving a primary patency rate of 95% and incidence of infection of <5%. From 1981-2010, the standard practice was to convert AV Shunt into AV Fistula after 4-6weeks or primary AVF was created asvascular access. Due to non-availability of AV Shunts, now we use Internal-jugular (IJ) catheter for acute dialysis. We have placed over 300 IJ catheters/year since 2014. However, the incidence of IJ catheter related blood stream infection is very high (around 90%) requiring catheter removal usually within 1 month of placement. We have put permcath in 10 patients last year, with average life of 1 year; with permcath thrombosis rates of 20% within 6 months.
Conclusion
To conclude, AV Shunt is still a viable, cost effective and preferred mode of vascular access in patients requiring hemodialysis and should be reintroduced in our practice.