Venkatnarayanan R, Dogra Pavitra Manu, Bavdekar Rohit, Singh Sanjeev Kumar, Mondal Asish Kumar
Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India.
Department of Nephrology, Army Hospital (R&R), New Delhi, India.
Indian J Nephrol. 2020 Nov-Dec;30(6):382-390. doi: 10.4103/ijn.IJN_214_19. Epub 2020 Nov 11.
Permanent vascular access is an essential intervention in patients with advanced chronic kidney disease (CKD) and its success depends on various non-modifiable and modifiable factors. Considering the element of unpredictability and failure, we attempted to analyze various factors responsible for primary arteriovenous fistula (AVF) failure in presumed high-risk groups.
We conducted an observational study of newly created AVFs at a tertiary referral government hospital in Eastern India between January 2014 and June 2015. All adult CKD patients undergoing AVF creation were included. Primary AVF failure was assessed at 12 weeks and total follow-up was 24 weeks in presumed high-risk groups of females, patients aged ≥65 years and those with diabetes mellitus.
Female gender was at a higher risk of primary AVF failure if aged ≥65 years ( = 0.0026), second AVF creation ( = 0.03), loupe magnification not used ( = 0.03), arterial plaque ( = 0.028), absent immediate thrill, and with radiocephalic AVF ( = 0.02). Absent immediate thrill (<0.0001) and AVF size ≤5 mm ( = 0.002) were important independent risk factors for primary failure. Diabetes or elderly age did not have additional risk, except with uncontrolled hypertension and female gender.
Female gender was at a higher risk of poor unassisted AVF patency if their age was ≥65 years, had second AVF creation, loupe magnification not used or if arterial plaque was present. An absence of thrill immediately or at 24 hours or an AVF diameter ≤5 mm were independent intraoperative factors for poor outcome. On the contrary, diabetics, elderly males and intimal thickness were essentially noncontributors for AVF failure, except in few subsets.
永久性血管通路是晚期慢性肾脏病（CKD）患者的一项重要干预措施，其成功与否取决于多种不可改变和可改变的因素。考虑到不可预测性和失败因素，我们试图分析假定高风险组中导致原发性动静脉内瘘（AVF）失败的各种因素。
我们于2014年1月至2015年6月在印度东部一家三级转诊政府医院对新创建的AVF进行了一项观察性研究。纳入所有接受AVF创建的成年CKD患者。在假定的高风险组女性、年龄≥65岁的患者以及糖尿病患者中，在12周时评估原发性AVF失败情况，总随访时间为24周。
年龄≥65岁的女性原发性AVF失败风险更高（P = 0.0026），二次AVF创建（P = 0.03）未使用放大镜放大（P = 0.03）、存在动脉斑块（P = 0.028）、即刻无震颤以及采用头静脉-桡动脉AVF（P = 0.02）。即刻无震颤（P<0.0001）和AVF尺寸≤5 mm（P = 0.002）是原发性失败的重要独立危险因素。糖尿病或老年本身并无额外风险，除非伴有未控制高血压和女性性别。
年龄≥65岁、二次AVF创建、未使用放大镜放大或存在动脉斑块的女性，其AVF无辅助通畅性较差的风险更高。即刻或24小时无震颤或AVF直径≤5 mm是预后不良的独立术中因素。相反，糖尿病患者、老年男性和内膜厚度基本上不是AVF失败的因素，但少数亚组除外。
