Santral venöz katateri olan hastalarda radyosefalik arteriyovenöz fistül matürasyonunu için prognostik faktörler ve inflamasyonla ilişkisi

Year 2020, , 124 - 132, 22.06.2020

Ali Baran Budak Tonguc Saba Nalan Akalın Gultekin Genctoy Cevahir Haberal

https://doi.org/10.18663/tjcl.739377

Abstract

Amaç:Matüre ve fonksiyonel bir arteriovenöz fistül (AVF), hemodiyaliz (HD) tedavisi tedavisinde vasküler erişim için en iyi modalite olarak kabul edilir; ancak erken başarısızlık oranı HD tedavisine santral venöz kateter (SVK) ile başlayan hastalarda yüksektir. Bu çalışmanın amacı, HD tedavilerine SVK ile başlayan ve daha sonra ilk kez radiosefalik AVF (RSAVF) oluşturulan hastalarda belirli hasta özelliklerinin ve spesifik inflamatuar belirteçlerin AVF’nin erken başarısızlığı açısından prognostik değeri ve ilişkisini incelemekti.
Gereç ve Yöntemler: Aynı cerrah tarafından, aynı teknik kullanılarak RSAVF oluşturulan ve konsülte edildiği sırada HD tedavisi için damar erişimi SVK ile önceden sağlanmış son-dönem böbrek hastalığı bulunan 168 hasta retrospektif olarak tarandı. Bu çalışmaya alınan hastalar Grup 1: erken başarısızlık olan (n=46) ve Grup 2: erken başarısızlık olmayan (n=122) olarak iki gruba ayrıldı. Bu hastaların, demografik özellikleri, yandaş hastalıkları, preoperatif doppler ultrasomografi haritalama sonuçları, laboratuar parametreleri, postoperatif takip detayları toplandı. Tüm hastaların primer patens oranları, erken başarısızlık oranı, maturasyon başarısızlık oranı ve SVK süreleri hesaplandı.
Bulgular: Kadın cinsiyet RSAVF erken başarısızlığında anlamlı bir risk faktörü olarak bulunmuştur (%69.5 vs %36.1; p=0.001). Sefalik ven çapı< 2 mm olan hastaların sayısı Grup 1’de fazlaydı (%78.3 vs %22.1 ; p=0.028). Grup 1’de SVK erişim süresi Grup 2’den anlamlı olarak daha uzundu (6.8 ± 3.6 ay vs 2.3 ± 1.7 ay; p<0.05). Maturasyon yetersizlik oranı %12.5 ve 1-yıllık primer patensoranı%72.6 idi.Grup 2’de, Grup 1’e oranla 1.yılda C-Reaktif Proteindüzeyleri (7.2 ± 9.6 vs 3.1 ± 3.3 mg/L, respectively; p=0.001) ve nötrofil lenfosit oranı(2.91± 0.30 vs 2.17 ± 0.22, respectively; p<0.05) anlamlı derecede düşüktü.
Sonuç: Önceden HD tedavisi için damar erişimi SVK ile sağlanan hastalarda, küçük sefalik ven çapı, kadın cinsiyet ve sistemik inflamasyon, ilk defa açılan RSAVF’ün erken başarısızlığında rol oynayabilir.

Keywords

otojen radyosefalik arteriovenöz fistül, erken başarısızlık, sefalik ven, inflamasyon

Prognostic factors for radiocephalic arteriovenous fistula maturation in patients with prior placement of a central venous catheter and relationship with inflammation

Abstract

Aim: A mature and functional arteriovenous fistula (AVF) is considered the best modality for vascular access(VA) for hemodialysis (HD) treatment but the incidence of early failure is high, especially in patients start their HD with a central venous catheter. The aim of this study was to evaluate the prognostic value and association of certain patient characteristics and specific inflammatory markers with early failure of AVF in patients who started their HD therapy with a CVC and a first autogenous radiocephalic AVF (RCAVF) was created after vascular consultation.
Material and Methods: A retrospective review of 168 patients with end-stage renal disease who underwent RCAVF creation by the same surgeon by using the same surgical technique and whose primary vascular access for HD treatment was obtained via CVC at the time of access consultation was performed. The patients enrolled into this study were categorized into two groups as Group 1: patients with early failure (n=46) and Group 2: patients with no failure (n=122).Demographic characteristics, medical comorbidities, preoperative doppler ultrasound mapping results, laboratory parameters, postoperative follow-up details of these patients were collected. Primary patency of all patients, early failure rate, maturation failure rate, duration of CVC was calculated.
Results: Female gender was found to be a significant risk factor in early failure of RCAVF (69.5% vs 36.1%; p=0.001). The number of patients whose diameter of cephalic vein< 2 mm were significantly higher in EF group (78.3% vs 22.1 ; p=0.028). The duration of CVC access of group 1 was significantly longer than group 2 (6.8 ± 3.6 months vs 2.3 ± 1.7 months, respectively; p<0.05). Overall maturation failure rate was 12.5% and primary patency at 1 year was 72.6%. Levels of C-Reactive protein (7.2 ± 9.6 vs 3.1 ± 3.3 mg/L, respectively; p=0.001) and neutrophil lymphocyte ratio (2.91± 0.30 vs 2.17 ± 0.22, respectively; p<0.05) was significantly lower at group 2 at one year.
Conclusion:In patients whose VA for HD treatment was provided by CVC, small cephalic vein diameter, female gender and systemic inflammation may play a role in early failure of RCAVF.

Keywords

autogenous radiocephalic arteriovenous fistula, early failure, cephalic vein, inflammation

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