Risk factors and complications of arteriovenous fistula in patients on cronic hemodialysis

Introduction: Arteriovenous fistula (AVF) is a surgical connection created between an adjacent artery and vein in patients undergoing chronic hemodialysis, The aim is to divert arterial blood into a vein, which becomes arterialized due to the newly established hemodynamics. AVF is widely recommended as the preferred vascular access for hemodialysis (HD), due to long-term therapy of patients with end-stage renal disease and significantly fewer complications compared to other vascular access options, such as Central Venous Catheter (CVC). However, despite the lower complication rate, AVF can still be associated with intraoperative, early, and late postoperative complications. Methodology: Recent scientific publications were thoroughly reviewed through PubMed, Scopus, SCI Index and other reference databases with a focus on risk factors and complications of arteriovenous fistula in patients on a chronic HD program. Topic: The most common AVF complications include: stenosis caused by hemodynamic and functional changes that cause narrowing of the blood vessel lumen by more than 50% and occurs on both the arterial and venous sides of the AV fistula. Thrombosis, which is the complete cessation of blood flow in the AVF venous segment proximal to the AV anastomosis. Aneurysm is a local expansion of a vein resulting from strong blood flow through the site of narrowing. Then the infection of the anastomosis that occurs due to careless and non-aseptic puncturing of the AVF and other complications of the AV fistula, such as pseudoaneurysm, hematoma, peripheral ischemia and heart complications. Conclusion: Thrombosis and stenosis are among the most common late complications of AVFs. This paper highlights the significance of AVFs as a permanent vascular access for hemodialysis and reviews the various complications and their associated risk factors. Scientific evidence from the literature emphasizes that proper and consistent AVF puncture technique can significantly delay the onset of these complications, underlining the importance of careful preoperative and ongoing management.