Lakhasly

our study, ischemic neuropathy was seen in 16.1% of the patients and was common in diabetic patients. It is often manifested by weak arms, in the immediate preoperative period, severe pain, and paresthesia.[27]
Although risk factors are important, risk stratification schemes based on demographic and clinical parameters fail to accurately identify individuals in whom AVF placement is futile. The most important determinant in the success of an AVF is the quality of the available vessels (i.e. hemodynamic factors).[28] Individualization based upon pre‐procedural vascular mapping is critical. As an example, an older black diabetic female with good vessels is a superior AVF candidate compared with a young white nondiabetic male with poor vessels. In a recent study done by Bae et al., it was suggested to undergo autologous AVF as the choice of vascular access in elderly HD (HD) patients.[29] Some studies revealed that the deaths in patients on HD are very minimal due to access‐related problems, and mediation analyses indicated that vascular access complications were not able to adequately explain the association between access type and death.[30,31] No patient with ESRD should be excluded from consideration for an AVF without vascular mapping and evaluation by an experienced HD access vascular surgeon. aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis.[21]
The choice of surgical technique for anastomosis has its own characteristics and it is a very important procedure to avoid certain surgical complications. End‐to‐end anastomosis requires a formidable surgical technique, especially when there is a discrepancy between the lumen of the arteries and veins. This can lead to ischemia of the distal extremities, especially in the elderly and patients with DM. Side‐to‐side anastomosis is technically easier and can be done if the blood vessels are close to each other. It must be noted that this type of anastomosis may lead to development of venous HTN. Currently, the most acceptable option is end‐to‐side anastomosis.[22‐24] When considering the complications some of the preoperative factors that should be considered are the outflow vein diameter, arterial diameter and flow rate in the vein and across the anastomosis, all of could have an effect on the success of fistulas, especially in proximal and distal arm fistulas.[25]
Infections accounts about 20% of all AVF complications and most common infections inlcude perivascular cellulitis, which manifests as localized erythema and edema and is usually easily treated. Much more serious is an infection associated with anatomical abnormalities, such as aneurysms, hematomas or abscesses, which require surgical excision and drainage.[