Experience of Physical Examination as a Primary Tool for Surgical Access Planning in Hemodialysis Patients
Keywords:Chronic kidney disease, CKD, Autogenous Arteriovenous Fistulas, AVFs, Hemodialysis, End stage renal disease, Fistula maturation, Arteriovenous Grafts
Background: Understanding the importance of pre-operative assessment is something nephrologists are probing for years to avoid any post-operative complication and AVF failure.
Objective: To assess the physical examination as primary tool as compared to Ultrasound Doppler in assessment of AVF planning in hemodialysis patients.
Materials and Methods: This was a Retrospective, Cross-sectional study. Secondary data was collected from the Urology Department of Liquate University of Medical and health sciences, Jamshoro starting from October 2021 to October 2022. For physical examination, both the arterial and venous circulation were evaluated. Arterial patency, pulse amplitude and Allen’s test were recorded. After collection of data, statistical Package for Social Science (SPSS) version 17. 0 statistical software was used for analysis.
Results: A total of 105 participants with mean age of 42.9 ± 13.9 years, 78 (74.3%) males and 27 (25.7%) females were included. The physical examination findings indicated facial swelling as the most frequently reported sign in with 59 (56.2%) of patients, followed by generalized body edema reported in 22 (21%) of participants. The estimated analysis of Allen’s test indicated good results with a mean of 12.4 ± 2.8 seconds in all patients, indicating good blood flow of the ulnar artery. The mean duration of hemodialysis was 55.2 ± 23.4 days before AVF, while central venous line duration was 57.2 ± 20.5 days. After 6 days fistula maturation was assessed, while mean fistula maturation duration was 44 ± 7.1 days.
Conclusion: To monitor functioning, the Physical Examination of vascular access is convenient, straightforward, and cost-effective. Physical examination (PE) has been validated with diagnostic techniques for detecting stenosis.