Mandeville Regional Hospital Marks 300 AV Fistula Surgeries, Expanding Dialysis Access in Southern Jamaica

MANCHESTER, Jamaica — A vascular surgery programme at Mandeville Regional Hospital (MRH) has crossed the 300-procedure mark over the last five years, widening haemodialysis options for hundreds of people across southern Jamaica who live with chronic kidney disease.

Consultant general surgeon Dr Varunesh Chand said the operation links an artery and a vein—usually in the forearm or upper arm—through a surgical connection known as an anastomosis. That link creates the long-term access point patients need for dialysis.

“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,” he said.

Before MRH launched the service in 2012, residents of southern Jamaica who required the procedure often had to make the journey to Kingston. Dr Akil Baker, who introduced the programme and is now a consultant at the University Hospital of the West Indies, built the foundation that Dr Chand has expanded since taking the lead in 2018.

As the principal referral facility for southern Jamaica, MRH treats roughly 200 dialysis patients annually. To keep pace with rising demand, the hospital runs a fixed weekly theatre slot devoted to AV fistula work.

Preoperative vein mapping carried out by surgeons, together with strong administrative backing, has helped the unit run smoothly enough to accept some cases referred from Spanish Town Hospital, easing pressure on facilities in the corporate area. MRH remains the only regional hospital in the zone providing this specialised service.

Programme performance has also held up on clinical measures. A 2024 review found that close to 80 per cent of fistulas matured successfully and were fit for haemodialysis use—a rate in line with outcomes reported at dedicated centres overseas.

“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,” Dr Chand added.