Siga Esteban Lucas, Ibalo Noemi, Benegas Maria R, Laura Farias, Luna Carlos, Aiziczon David H, Demicheli Elvio
Dialisis Madariaga, General Carlos Madariaga, Buenos Aires, Argentina.
Hospital Interzonal de Agudos, Mar del Plata, Buenos Aires, Argentina.
J Bras Nefrol. 2019 Jul-Sep;41(3):330-335. doi: 10.1590/2175-8239-JBN-2018-0125. Epub 2019 Apr 11.
Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively.
This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium.
We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003).
Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF.
动静脉内瘘（AVF）是最佳的血液透析血管通路，但其失败率仍然很高。很少有研究探讨血管外科医生的技术和医疗机构的操作所起的作用。我们旨在研究这些因素，假设外科医生的技术和医疗机构的操作分别对初次失败率和12个月时的通畅率具有重要作用。
这是一项于2005年3月至2017年3月进行的单中心前瞻性队列研究。仅纳入初发患者。由一名外科医生制作所有的动静脉内瘘，部位在前臂（低位）或肘部（高位）。血管通路的定义符合北美血管通路协会的标准。
我们研究了106例患者的113个动静脉内瘘（65%为低位）（39%为糖尿病患者，58%起始使用导管）。首次连接时间为21.5天（四分位间距：14 - 31天）。仅有14个动静脉内瘘（12.4%）发生初次失败，18个在第一年内失败。功能性初次通畅率为80.9%（标准误4.1），而包括初次失败在内的初次非辅助通畅率为70.6%（4.4）。逻辑回归显示糖尿病（比值比=3.3，95%置信区间1.38 - 7.88，p = 0.007）和前臂部位（比值比=3.03，95%置信区间1.05 - 8.76，p = 0.04）是动静脉内瘘失败的预测因素。在非糖尿病患者中，低位和高位动静脉内瘘的通畅率相似，而低位动静脉内瘘的糖尿病患者通畅率低于50%。（p = 0.003）
结果表明，几乎所有患者都可行建立持久、合适的动静脉内瘘。外科医生的技术和医疗机构的操作对动静脉内瘘的长期结局可能具有重要作用。
