The call for interventional nephrology has come from all corners of the world. The reason for the need varies from centre to centre, depending on the geographic location and the economic status. Facility for renal disease management and availability of specialist doctors are scarce in developing countries and more so in remote centres.
Training for AVF construction, generally does not find a place in the curriculum of the Urologist, Vascular surgeon or General surgeon. Yet traditionally one of them does the job for the Nephrologist. Out of sheer necessity, AV Fistula construction was taken over by the Nephrologist at the Kidney Care Centre which is located far away from the large cities and institutions in the southern most part of India.
Method:
From April 2000 to Jan 2003, 263 AVFs were created by the Nephrologist. The results and complications of the procedures were studied and compared with 100 AVFs created by the Surgeon in the same centre.
Results:
|
|
Total |
Male/Female |
Age range yrs |
Age yrs |
|
Nephrologist |
263 |
198 / 67 |
8 - 78 |
48 |
|
Surgeon |
100 |
72 / 28 |
12 - 74 |
42 |
|
|
Left / Right |
Snuff./Wrist/Forearm/Elbow |
Time taken |
Function |
Waiting |
Complic.% |
|
Nephrologist |
204 / 61 |
120 / 115 / 20 / 4 |
75 mts |
85% |
1 day |
10 |
|
Surgeon |
65 / 35 |
0 / 76 /20 / 4 |
55 mts |
94% |
4 days |
22 |
|
p value |
|
<0.05 |
|
|
<0.05 |
<0.05 |
Nephrologist made more distal fistulas preserving proximal vessels for potential future use; more of left sided fistulas; had better success rates; had less complications; less waiting time. More chances of successful intervention and salvage of impending fistula thrombosis -because of proximity, availability and willingness.
Additional advantages observed were:
1. Was able to assess the atherosclerotic status of the artery in person and this had good correlation with the internal iliac artery during renal transplantation.
2. Was able to develop better rapport with the patient. As the need and urgency of the patient was better understood by the nephrologist, access planning was more successful.
3. Was able to cut down the cost.
Conclusion:
AVF by Nephrologist is very much feasible and even better.
