Mandeville Hospital's AV fistula program reaches 300 surgeries, improving dialysis access

Mandeville Regional Hospital (MRH) in Manchester, Jamaica, has reached a significant milestone, successfully completing 300 arteriovenous (AV) fistula surgeries over the past five years. This achievement has dramatically improved access to hemodialysis treatment for hundreds of patients suffering from chronic kidney disease across southern Jamaica.

Dr. Varunesh Chand, a consultant general surgeon at MRH, explained that the AV fistula surgery creates a connection between an artery and a vein, typically in the arm. This procedure provides the durable vascular access necessary for hemodialysis. "AV fistulas are widely regarded as the preferred access option because they are more durable, carry a lower risk of infection, and generally result in fewer complications than dialysis catheters," Dr. Chand stated.

Before the establishment of this service at MRH in 2012, patients in southern Jamaica had to travel to Kingston for the procedure. The service, initially introduced by Dr. Akil Baker, has flourished under Dr. Chand's leadership since 2018. As the primary referral hospital for the region, MRH serves approximately 200 dialysis patients annually and maintains a dedicated weekly operating schedule for AV fistula procedures.

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AV fistulas are widely regarded as the preferred access option because they are more durable, carry a lower risk of infection, and generally result in fewer complications than dialysis catheters.

The program's efficiency has even allowed for referrals from Spanish Town Hospital, easing the burden on facilities in the capital. A 2024 review indicated a nearly 80% success rate for fistula maturation, a figure on par with specialized international centers. Dr. Chand emphasized the importance of timely referrals, noting that ideally, a functional AV fistula should be in place even before a patient begins dialysis.

"Timely referral for access creation is also essential to reduce morbidity faced by patients," Dr. Chand added. "In chronic kidney disease, ideally, we want to have a functional AV fistula even before the patient starts dialysis. Dr Kristen Little, Sister Marika Davis-Miller and the rest of the renal team at MRH have done an excellent job in getting patients evaluated as soon as possible."

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Timely referral for access creation is also essential to reduce morbidity faced by patients. In chronic kidney disease, ideally, we want to have a functional AV fistula even before the patient starts dialysis. Dr Kristen Little, Sister Marika Davis-Miller and the rest of the renal team at MRH have done an excellent job in getting patients evaluated as soon as possible.