Virginia Commonwealth University School of Medicine, Richmond, VA.
Virginia Commonwealth University Health System, Richmond, VA; Central Virginia VA Health Care System, Richmond, VA.
Ann Vasc Surg. 2021 Aug;75:280-286. doi: 10.1016/j.avsg.2021.01.073. Epub 2021 Feb 4.
Radiocephalic arteriovenous fistula (RCAVF) creation is the preferred first line hemodialysis access procedure. Analysis of diabetic rat arteriovenous fistula model indicates improved vascular function with HMG-CoA-Reductase Inhibitor (statin) use. We predict similar outcomes in diabetic patients undergoing primary RCAVF placement.
A Veterans Administration Hospital dialysis access database over a 15-year period was queried identifying all RCAVF placements in diabetic patients. Patients were stratified into statin medication usage or not at RCAVF creation. Outcomes examined include rate of successful cannulation, functional patency duration, interventions per access, and rates of access thrombosis. Thrombosis-free survival of cannulated RCAVFs were compared using Kaplan-Meier method with log-rank analysis followed by univariate, stepwise logistic regression and ROC curve analysis.
Total number of 123 RCAVF cases were performed in 122 diabetic male patients. At the time of RCAVF placement, 92 cases were performed on patients that were taking statin medication and 31 cases were performed on patients that were not taking statin medication. There was no difference in terms of rate of successful cannulation, functional patency duration, and number of interventions per access between the statin and non-statin groups. However, rate of RCAVF thrombosis once accessed was significantly lower in the statin group compared to the non-statin group (P = 0.0005). Kaplan-Meier survival curve for each group were compared using log-rank test to reveal that diabetic patients who were on statin therapy at the time of operation had significantly higher access survival over time against thrombosis once it was cannulated for dialysis treatment compared to those who were not on statin therapy (P = 0.0003). Univariate, stepwise logistic regression model indicated statin use as the only significant factor associated with lack of thrombosis (P = 0.05).
Statins appear to have protective effects against RCAVF thrombosis as predicted in animal models for diabetic patients undergoing primary RCAVF placements. There were similar functional outcomes in terms of rate of successful cannulation, functional patency duration, and number of interventions per access. These data should encourage further investigation of statins and their role in hemodialysis access.
头臂静脉动静脉瘘（RCAVF）的建立是首选的血液透析通路程序。对糖尿病大鼠动静脉瘘模型的分析表明，使用羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）可改善血管功能。我们预测在接受初次 RCAVF 置管的糖尿病患者中也会出现类似的结果。
在 15 年的时间里，我们对退伍军人事务部医院的透析通路数据库进行了查询，确定了所有糖尿病患者的 RCAVF 置管术。将患者分为他汀类药物使用和不使用两种情况。观察的结果包括成功置管率、功能通畅持续时间、每个通路的干预次数以及通路血栓形成率。使用 Kaplan-Meier 方法比较了有血栓形成和无血栓形成的 RCAVF 通路的存活率，采用对数秩检验进行分析，然后进行单变量、逐步逻辑回归和 ROC 曲线分析。
共对 122 例糖尿病男性患者的 123 例 RCAVF 进行了手术。在 RCAVF 置管时，92 例患者正在服用他汀类药物，31 例患者未服用他汀类药物。他汀类药物组和非他汀类药物组在成功置管率、功能通畅持续时间和每个通路的干预次数方面无差异。然而，在接受他汀类药物治疗的患者中，RCAVF 血栓形成的发生率明显低于未接受他汀类药物治疗的患者（P = 0.0005）。通过对数秩检验比较两组的 Kaplan-Meier 生存曲线，结果显示，与未接受他汀类药物治疗的患者相比，在接受他汀类药物治疗的糖尿病患者中，在接受透析治疗时进行置管后，通路的血栓形成时间明显更长（P = 0.0003）。单变量、逐步逻辑回归模型表明，他汀类药物的使用是唯一与无血栓形成相关的显著因素（P = 0.05）。
他汀类药物似乎对糖尿病患者初次 RCAVF 置管后具有预防 RCAVF 血栓形成的作用，这与动物模型的预测结果一致。在成功置管率、功能通畅持续时间和每个通路的干预次数方面，两组的功能结果相似。这些数据应该鼓励进一步研究他汀类药物及其在血液透析通路中的作用。
