Joseph Lo Zhiwen, Tay Wee Ming, Lee Qinyi, Chua Jia Long, Tan Glenn Wei Leong, Chandrasekar Sadhana, Narayanan Sriram
Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore - Singapore.
J Vasc Access. 2016 Sep 21;17(5):411-416. doi: 10.5301/jva.5000591. Epub 2016 Aug 2.
To identify predictors of arteriovenous fistula (AVF) patency in Asian patients with autogenous radio-cephalic arteriovenous fistula (RCAVF).
Retrospective review of 436 RCAVFs created between 2009 and 2013. Predictors of patency were identified with univariate and multivariate analysis. Kaplan-Meier survival analysis and log-rank test were used to calculate patency rates.
Overall secondary patency rate was 72% at 12 months, 69% at 24 months, 58% at 36 months, 57% at 48 months, 56% at 60 months and 54% at 72 months. Univariate analysis showed that factors which predict for patency include male gender (p = 0.003), good diabetic control (p = 0.025), aspirin use (p = 0.031), pre-dialysis status (p = 0.037), radial artery diameter (p = 0.029) and non-calcified radial arteries (p = 0.002). Age (p = 0.866), cephalic vein diameter (p = 0.630) and surgeon grade (p = 0.472) did not predict for primary AVF failure. Multivariate analysis revealed the male gender to be an independent predictor for patency (odds ratio 1.99, p = 0.01). Subset analysis showed a significantly larger average radial artery diameter of 2.3 mm amongst males, as compared to 1.9 mm amongst females (p = 0.001) and no statistical difference in the average cephalic vein diameter.
Within our Asian study population, 12-month patency rate of RCAVF is 72%, 69% at 24 months, 58% at 36 months, 57% at 48 months, 56% at 60 months and 54% at 72 months. Male gender is an independent predictor for RCAVF patency. In females or patients with calcified radial arteries, a more proximal AVF should be considered.
确定亚洲自体桡动脉-头静脉内瘘（RCAVF）患者动静脉内瘘（AVF）通畅的预测因素。
回顾性分析2009年至2013年间建立的436例RCAVF。通过单因素和多因素分析确定通畅的预测因素。采用Kaplan-Meier生存分析和对数秩检验计算通畅率。
总体二次通畅率在12个月时为72%，24个月时为69%，36个月时为58%，48个月时为57%，60个月时为56%，72个月时为54%。单因素分析显示，预测通畅的因素包括男性（p = 0.003）、良好的糖尿病控制（p = 0.025）、使用阿司匹林（p = 0.031）、透析前状态（p = 0.037）、桡动脉直径（p = 0.029）和非钙化桡动脉（p = 0.002）。年龄（p = 0.866）、头静脉直径（p = 0.630）和外科医生级别（p = 0.472）不能预测原发性AVF失败。多因素分析显示男性是通畅的独立预测因素（优势比1.99，p = 0.01）。亚组分析显示，男性平均桡动脉直径显著大于女性，分别为2.3 mm和1.9 mm（p = 0.001），而平均头静脉直径无统计学差异。
在我们的亚洲研究人群中，RCAVF的12个月通畅率为72%，24个月时为69%，36个月时为58%，48个月时为57%，60个月时为56%，72个月时为54%。男性是RCAVF通畅的独立预测因素。对于女性或桡动脉钙化的患者，应考虑建立更近端的AVF。
