Dr Himanshu Verma
End-stage renal failure has emerged as a grave global health crisis, impacting countless individuals worldwide. With kidney transplants limited to a small percentage of patients, the majority must rely on lifelong haemodialysis to survive.
However, the scarcity of resources and skilled healthcare professionals has made this a daunting challenge, with the spectre of death ominously looming over those affected.
The creation of an arteriovenous (AV) fistula plays a vital role in facilitating effective haemodialysis and improving the quality of life for end-stage renal failure patients. By surgically connecting an artery and a vein, an AV fistula forms a prominent vein with robust blood flow. During each dialysis session, two needles are inserted into the vein: one to send blood to the dialysis machine and another to return purified blood to the body. This process, repeated 2-3 times weekly, becomes a lifelong necessity for most patients. However, over time, AV fistulas may deteriorate, requiring additional procedures like angioplasty to sustain functionality. Unfortunately, many fistulas eventually become blocked, necessitating further AV fistula creation.
The scarcity of highly skilled AV fistula surgeons poses a significant challenge in providing adequate care for end-stage renal failure patients. It is only vascular surgeons who possess the comprehensive expertise needed not only to create optimal AV fistulas but also to provide diligent surveillance, timely interventions to prevent occlusion, and the ability to create AV fistulas for patients with previous failures.
Upon arriving in Delhi in 2016, I discovered that a majority of failed AV fistula patients relied on Permacath, a line placed in the neck for dialysis. It’s only a matter of time before Permacath leads to neck infections or vein blockages, tragically shortening the patient’s life. With my vascular expertise, I have been able to provide AV fistulas for over 90% of patients deemed impossible to treat. I now consider over 200 patients as my extended family, relying on me for their AV fistula maintenance. This responsibility fills me with a profound sense of duty, and these patients feel like dear friends. The time we spend together caring for their fistulas creates a unique bond, motivating me to go above and beyond in their treatment. After all, it’s all about taking care of a lifeline for a lifetime.
It is imperative that governments, healthcare organizations, and medical professionals come together to address the global health crisis of end-stage renal failure. Increased investment in the training and development of skilled vascular surgeons, along with the allocation of resources for research and development, will be crucial in finding innovative solutions to improve the quality of life for patients.
The time to act is now. Let us join forces to ensure that every end-stage renal failure patient receives the care they deserve, and no one is left behind in the face of this daunting challenge.
(The author is Sr Consultant Vascular & Endovascular Surgery, Fortis Hospital, Gurugram)
