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Abstract
Renal Failure occurs when the functioning renal mass is reduced sufficiently that the kidney is no longer able to carryout excretory function.
When conservative measures in acute or chronic renal failure produces no response then dialysis is the effective line of treatment.
The most important feature of any form of vascular access is its length of usage as a functioning access. Requirements of a successful vascular access procedure for hemodialysis are a high blood flow (at least 200 ml/min), a diameter which is large enough to allow easy connulation, a sufficient length to allow two needles to be inserted and facilitate the rotation of needle sites, its technical simplicity and quick operation under local anaesthetic, alow complication rate as regard to infection and thrombosis and a good longterm patency rate.
Complications of arteriovenous fistula include thrombosis, infection, arterial steal phenomena, aneurysms, congestive heart failure and venous hypertension of the hand.
Venous hypertension manifested by minimal hand swelling is quite common in hemodialysied patients with upper extremety access. The manifestations may be more severe in some patients who develop venous ulcer leading to digit gangrene or even hand loss .
This study included twenty patients with end stage renal disease on regular hemodialysis. All patients were suffering from venous hypertension. They were recruited from the out patient clinic and thedialysis unit at Gamal Abd El Nasser Hospital, Alexandria from July 2007to June 2009.
Patients present with swelling, change of skin colour(Hyperpigmentation), cynosis, pain, impaired fingers function and some patients presnt with venous ulcers .
The clinical diagnosis and the cause of venous hypertension was confirmed by duplex scanning .
In our study, cases were treated by conservative treatment , distal limb ligation, selective vien ligation and closure of AVF.
The choice of management is essentially accordance to clinical assessment. Conservative measures were applied for fistulae associated with mild venous hypertension, closure of the fistula was done for venous hypertension of whole upper limb due to central vein stenosis or occlusion after failure of conservative measures, ligations of tributary veins to the access was done in the end to side fistula and distal vein ligation was done in side to side fistula.
In patient with venous out flow obstruction closure of the fistula was done and resolve the problem.
Recently some cases of venous hypertension duo to venous out flow obstraction were treated by endovascular procedure (angioplasty with stenting). But this procedure was not used in this study .