Son dönem kronik böbrek yetmezlikli hastalarda hemodiyaliz amaçlı yapılan distal radiyosefalik yanyana anastomozların değerlendirilmesi
Abstract
Amaç: Son dönem böbrek yetmezliği (SDBY) hastalarında, damar erişim yolu olarak kullanılan distal radiyosefalik yanyana anastomoz yapılarak sefalik ven distali bağlanmadan oluşturulan arteriyovenöz fistüllerin (AVF) erken ve geç dönem açıklık oranlarını, olgunlaşma sürelerini, komplikasyon oranlarını değerlendirmek ve fistüllerde meydana gelen sorunların tanı ve tedavisinin daha kolay ve minimal invaziv yöntemlerle yapılabileceğini ortaya koymaktır.
Gereç ve Yöntemler: Haziran 2012 ve Aralık 2015 tarihleri arasında SDBY hastalarında yapılan arteriyovenöz fistüller değerlendirildi. Hastaların demografik bilgileri, muayene bulguları, fistüle bağlı komplikasyonları ve komplikasyonların tedavileri incelendi. Hastaların 1. gün, 1. hafta, 1. ay, 1. yıl poliklinik kontrol muayeneleri yapıldı.
Bulgular: 50 hastanın 1. gün 5 (%10) hastanın fistülünde tromboz saptandı, bu hastalara safen ven distalinden girilerek Fogarty kateteri yardımıyla trombektomi yapıldı, 2 hastanın trombektomi sonrası fistülleri çalışmaya devam etti. 3 hasta erken dönemde kontrollere gelmeyerek takip dışı bırakıldı. 1. ayda takip edilen 47 hastadan 37 hastanın fistülü müdahalesiz ve 2 hastanın fistülü trombektomi sonrası çalışmakta idi. Erken dönem primer açıklık oranı %78,7 ve sekonder açıklık oranı %82,9 olarak saptandı. 2 hasta ilk 1 yıl içinde olmak üzere toplam 7 hasta ek hastalıkları nedeniyle kaybedildi. 1 yıllık takiplerini tamamlayan 45 hastadan 33(%76,7) tanesinin fistülü müdahalesiz ve erken dönemde trombektomi yapılan 2 hasta ile toplam 35(%81.3) hastanın fistülü çalışmakta idi. 1 yıllık primer açıklık oranı %76,7 ve sekonder açıklık oranı %81,3 olarak saptandı. Hastalarda venöz hipertansiyon veya distal iskemi gibi herhangi bir komplikasyon gelişmedi.
Sonuç: SDBY hastalarında distal radiyosefalik yanyana anastomoz ile oluşturulan ve sefalik ven distali bağlanmayan arteriyovenöz fistüller damar erişim yolu olarak başarılı şekilde kullanılabilmektedir.
Keywords
Son dönem böbrek yetmezliği arteriyovenöz fistül komplikasyon yan-yana anastomoz hemodiyaliz
References
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An evaluation of distal radiocephalic side-to-side anastomosis performed for hemodialysis in patients with end-stage chronic renal failure
Abstract
Aim: In our study we evaluate the early and late term patency ratio, time to maturation and fistula associated complication rates in cases with an arteriovenous fistula (AVF) created via a distal radiocephalic side-to-side anastomosis without ligation of distal cephalic vein in patients with end-stage renal failure (ESRF) and suggest that the fistulae complications can be diagnosed and treated with simpler and minimally-invasive methods.
Methods: The demographic data, outpatient clinic follow-up records on day 1, week 1, month 1 and year 1, fistula-related complications and treatments given for complications of patients were evaluated.
Results: Of the 50 operated patients, five(10%) developed fistula thrombosis on postoperative day 1 and underwent thrombectomy with a Fogarty catheter inserted via the distal cephalic vein; the fistula remained active after thrombectomy in two patients. Of the 47 patients followed at Month 1, 37 had a functional fistula and two had a functional fistula following thrombectomy. The early-term primary and secondary patency ratio was 78.7% and 82.9%, respectively. Of the 45 patients who attended the 1-year follow-up, 33(76.7%) had a non-intervened fistula, and with the addition of the two patients who underwent early-term thrombectomy, 35(81.3%) patients in total had fully functional fistulae. The one-year primary and secondary patency ratio was 76.7% and 81.3%, respectively. None of the patients developed such complications as venous hypertension or distal ischemia.
Conclusions: Arteriovenous fistula created via distal radiocephalic side-to-side anastomosis without ligation of distal cephalic vein can be successfully used as a vascular access in patients with ESRF.
References
- 1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-S266.
- 2. Karim MS, Aryal P, Gardezi A, et al. Vascular access in kidney transplant recipients. Transplant Rev (Orlando). 2020;34(3):100544. https://doi.org/10.1016/j.trre.2020.100544
- 3. NKF KDOQI GUIDELINES. Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates. http://kidneyfoundation.cachefly.net/professional/ KDOQI/guideline_upHD_PD_VA/index.htm 2006. Accessed 056/01/2019 2019.
- 4. Sedlacek M, Teodorescu V, Falk A, et al. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis. 2001;38(3):560-4. https://doi.org/10.1053/ajkd.2001.26873
- 5. Lin SL, Huang CH, Chen HS, Hsu WA, Yen CJ, Yen TS. Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol. 1998;18(2):96-100. https://doi.org/10.1159/000013315
- 6. Murphy GJ, Nicholson ML. Autogeneous elbow fistulas: the effect of diabetes mellitus on maturation, patency, and complication rates. Eur J Vasc Endovasc Surg. 2002;23(5):452-7. https://doi.org/10.1053/ejvs.2002.1613
- 7. Lauvao LS, Ihnat DM, Goshima KR, et al. Vein diameter is the major predictor of fistula maturation. J Vasc Surg. 2009;49(6):1499-504. https://doi.org/10.1016/j.jvs.2009.02.018
- 8. Mousa Albeir Y, David D, Ali F. Radiocephalic fistula: review and update. Annals of Vascular Surgery 2013;27:370-8. https://doi.org/10.1016/j.avsg.2012.07.012
- 9. Hong SY, Yoon YC, Cho KH, et al. Clinical Analysis of Radiocephalic Fistula Using Side-to-side Anastomosis with Distal Cephalic Vein Ligation. Korean J Thorac Cardiovasc Surg. 2013;46(6):439-3. https://doi.org/10.5090/kjtcs.2013.46.6.439
- 10. Schanzer H, Kaplan S, Bosch J,et al. Double-lumen, silicone rubber, indwelling venous catheters. A new modality for angioaccess. Arch Surg. 1986;121(2):229-32. https://doi.org/10.1001/archsurg.1986.01400020115014
- 11. Rooijens PP, Tordoir JH, Stijnen T, et al. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg. 2004;28(6):583-9. https://doi.org/10.1016/j.ejvs.2004.08.014
- 12. Park SC, Ko SY, Kim JI, et al. Balloon-assisted maturation for arteriovenous fistula maturation failure: an early period experience. Ann Surg Treat Res. 2016;90(5):272-8. https://doi.org/10.4174/astr.2016.90.5.272
- 13. Tordoir JHM, Zonnebeld N, van Loon MM, et al. Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence. Eur J Vasc Endovasc Surg. 2018;55(2):240-8. https://doi.org/10.1016/j.ejvs.2017.12.001
- 14. Spanuchart I, Amin B, Sequeira A, et al. Catheter-directed thrombolytic infusion for thrombosed arteriovenous fistulas with a large clot burden: A case series. J Vasc Access. 2022;23(6):950-5. https://doi.org/10.1177/11297298211011916
- 15. Roy-Chaudhury P, Lee T, Woodle B, et al. Balloon-assisted maturation (BAM) of the arteriovenous fistula: the good, the bad, and the ugly. Semin Nephrol. 2012;32(6):558-63. https://doi.org/10.1016/j.semnephrol.2012.10.007
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Articles |
| Authors | |
| Publication Date | April 30, 2023 |
| Acceptance Date | February 18, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 1 |
