Dr. Shahnawaz, MS, Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
Dr. Shahzad Ali, FCPS, Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
Pak J Med Sci. 2013 Jan;29(1):161-5. doi: 10.12669/pjms.291.2753.
To evaluate the two year patency rate of functioning arteriovenous fistula.
This prospective case series study was conducted at Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from 1(st) January 2009 to 31(st) December, 2010. Patients were chosen for CBRC arteriovenous fistula at wrist and patients undergoing other types of vascular access or secondary fistula formation were excluded.
One hundred and eighty two patients underwent arteriovenous fistula formation. The mean ± SD age was 63 ± 13 years and there were 102 (56%) males and 80 (44%) females. 12.6% fistulae failed within first month without dialysis. The primary patency rate was 66.5% at three months and 57.7% at six months. Failing arteriovenous fistula was managed by new arteriovenous fistula in our series. 28.6% patients had redo arteriovenous fistula. This study demonstrated a poor outcome for fistulas in diabetic patients. Fifteen out of 23 (65.2%) who failed primarily were diabetics and out of these diabetics 13 (86.7%) failed in first three months. Infection and burst fistulae were found in nine (4.9%), pseudo aneurysm in 3.2%, fever 4.9%, peri-operative failure 0.55% and burst fistulae 3.2%.
One-third of radiocephalic fistulas fail within two years. The outcome is worse for women and diabetic patients. This information may be useful in assessing and counseling patients with end-stage renal failure. Arteriovenous fistula is the better and ideal choice for haemodialysis. A Radiocephalic fistula in forearm seems to have better results as comparison to cubital fossa arteriovenous fistula. End to side anastomosis results are better than side to side anastomosis.
评估功能动静脉瘘两年通畅率。
本前瞻性病例系列研究于 2009 年 1 月 1 日至 2010 年 12 月 31 日在卡拉奇吉纳纳研究生医学中心泌尿科进行。选择腕部 CBRC 动静脉瘘患者，排除其他类型血管通路或继发性瘘形成患者。
182 例患者行动静脉瘘成形术。平均年龄±标准差为 63±13 岁，其中 102 例（56%）为男性，80 例（44%）为女性。12.6%的瘘管在第一个月无透析前失败。三个月时初始通畅率为 66.5%，六个月时为 57.7%。失败的动静脉瘘在本研究中通过新的动静脉瘘来治疗。28.6%的患者进行了再次动静脉瘘。该研究表明糖尿病患者的瘘管预后较差。23 例原发性失败患者中，15 例（65.2%）为糖尿病患者，其中 13 例（86.7%）在头三个月失败。9 例（4.9%）出现感染和爆裂瘘，3.2%出现假性动脉瘤，4.9%出现发热，0.55%出现围手术期失败，3.2%出现爆裂瘘。
三分之一的头静脉瘘在两年内失败。女性和糖尿病患者的结果更差。这些信息可能有助于评估和咨询终末期肾衰竭患者。动静脉瘘是血液透析的更好和理想选择。前臂头静脉瘘的结果似乎优于肘窝动静脉瘘。端侧吻合的结果优于侧侧吻合。
