Fokou Marcus, Ashuntantang Gloria, Teyang Abel, Kaze Francois, Chichom Mefire Alain, Halle Marie Patrice, Angwafo Fru, Takongmo Samuel, Sandmann Wilhelm
Department of Surgery, Yaoundé General Hospital, Yaounde, Cameroon.
Ann Vasc Surg. 2012 Jul;26(5):674-9. doi: 10.1016/j.avsg.2011.07.019. Epub 2012 Jan 27.
To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them.
From November 2002 to November 2009, 518 fistulas were constructed on adults. Demographic data, patency, and complications were analyzed. The association between age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and complications as well as AVF patency on the other was sought.
Males represented 73.7% of the patient population, and the mean age of the population was 45.3 years. As far as etiologies of end-stage renal disease (ESRD) and comorbidities are concerned, chronic glomerulonephritis was the leading cause of ESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% of patients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRD could be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascular access. The main types of AVF constructed were radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188 complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and 10.63% of cases, respectively. The management options for the complications included the creation of a new access for 63 complications (33.51%) and nonoperative management in 44.14% of the cases. We found no adverse effect of comorbid factors like diabetes mellitus (χ(2) = 3.58, P > 0.05) and HIV-positive status (χ(2) = 0.64, P > 0.05) on the complications rate.
According to our patients' characteristics, there is a possibility of constructing AVF on nearly every hemodialysis patient with a good outcome.
从患者特征、通畅率和并发症发生率以及影响这些因素的方面，介绍撒哈拉以南非洲地区用于血液透析的动静脉内瘘（AVF）的特殊情况。
2002年11月至2009年11月，为成人构建了518个内瘘。分析了人口统计学数据、通畅率和并发症情况。研究年龄、性别和合并症（HIV、高血压、糖尿病）一方面与并发症以及AVF通畅率另一方面之间的关联。
男性占患者总数的73.7%，患者平均年龄为45.3岁。就终末期肾病（ESRD）的病因和合并症而言，慢性肾小球肾炎是ESRD的主要病因（134例；25.9%），其次是高血压（22.3%），尽管在83.2%的患者中普遍存在，以及糖尿病（20.1%），尽管在22.2%的患者中普遍存在。89例患者（17.2%）无法确定ESRD的病因。只有20.64%的患者最初采用AVF作为血管通路。构建的AVF主要类型为桡动脉 - 头静脉内瘘（68%）和肱动脉 - 头静脉内瘘（24.9%）。中位随访期为275天。1年和2年的累积通畅率分别为76%和51%。共有16%的AVF发生了188例并发症。动脉瘤、未成熟和血栓形成是最常见的并发症，分别发生在27.65%、14.89%和10.63%的病例中。并发症的处理选择包括为63例并发症（33.51%）建立新的通路，44.14%的病例采用非手术处理。我们发现糖尿病（χ² = 3.58，P > 0.05）和HIV阳性状态（χ² = 0.64，P > 0.05）等合并因素对并发症发生率没有不良影响。
根据我们患者的特征，几乎每个血液透析患者都有可能构建AVF并取得良好效果。
