Department of Nephrology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, India.
Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, India.
Int Urol Nephrol. 2022 Jan;54(1):185-192. doi: 10.1007/s11255-021-02908-5. Epub 2021 Jun 6.
Arteriovenous fistula(AVF) is preferred vascular access for hemodialysis but has primary failure in 20-60%. Studying predictors of AVF failure would help plan appropriate management.We studied AVF outcomes, clinical and vascular factors predicting their failure in patients requiring hemodialysis.
Retrospective study of patients with AVF creation from January 2017 to December 2018. Outcomes studied were immediate (< 72 h), primary (3 months) AVF failure, six-month/one-year patency, analyzed for predictive clinical, vascular factors as assessed using Pre-operative Doppler Ultrasound(DUS).
Of 530 AVFs in 460 patients, DUS was done in 426/530 (80.4%), 349/460 (75.8%) were males, mean age was 53.10 ± 14.54 (18-91), 215/460(46.7%) had Diabetes mellitus(DM), 423/460(92%) hypertension. AVFs were radiocephalic in 79/530 (14.9%), brachiocephalic 418/530 (78.9%), brachiobasilic 33/530 (6.2%). AVF Immediate/Primary failure was seen in 64/530 (12.1%), 90/352 (25.6%); Patency at six months/one year in 253/352(71.8%),191/305 (62.6%), respectively. Older age had less immediate failures (AOR 0.97, CI 0.95-0.99, p 0.03). Feeding arterial diameter predicted immediate and primary failure on univariate analysis [OR 0.64 (95% CI 0.49-0.83), 0.62 (95% CI 0.47-0.89), respectively], but not multivariate. Artery diameter of > 4.0 mm had less failures [immediate (p 0.01), primary (p 0.02)], < 2.0 mm had specificity 95.9% and 95.4% for immediate, primary failure respectively.
AVF failure is 12.1%, immediately; 25.6% three months after construction, Patency at 6 months is 71.8%, one year 62.6%. Immediate failures decrease with age. Artery diameters > 4.0 mm had less, < 2.0 mm had more failures.
动静脉瘘（AVF）是血液透析的首选血管通路，但有 20-60%的患者会出现原发性失败。研究 AVF 失败的预测因素有助于规划适当的管理。我们研究了需要血液透析的患者的 AVF 结局、临床和血管因素对其失败的预测。
回顾性研究 2017 年 1 月至 2018 年 12 月期间 AVF 造口术的患者。研究的结果是即时（<72 小时）、原发性（3 个月）AVF 失败、6 个月/1 年通畅率，使用术前多普勒超声（DUS）评估预测性临床、血管因素。
在 530 例 AVF 中，有 426/530（80.4%）例进行了 DUS，349/460（75.8%）例为男性，平均年龄为 53.10±14.54（18-91）岁，215/460（46.7%）例患有糖尿病（DM），423/460（92%）例患有高血压。AVF 为桡动脉头静脉（79/530）14.9%，肱动脉头静脉（418/530）78.9%，肱动脉尺动脉（33/530）6.2%。530 例中有 64/530（12.1%）例出现即时/原发性失败，90/352（25.6%）例出现通畅率失败；352 例中有 253/352（71.8%）例在 6 个月/1 年内保持通畅，191/305（62.6%）例保持通畅。年龄较大的患者即时失败的发生率较低（AOR 0.97，95%CI 0.95-0.99，p=0.03）。供血动脉直径在单因素分析中预测即时和原发性失败[OR 0.64（95%CI 0.49-0.83），0.62（95%CI 0.47-0.89）]，但在多因素分析中则不然。直径>4.0mm 的动脉发生失败的可能性较小[即时（p=0.01），原发性（p=0.02）]，直径<2.0mm 的动脉即时失败的特异性为 95.9%，原发性失败的特异性为 95.4%。
AVF 失败的发生率为 12.1%，即刻发生；3 个月后为 25.6%，6 个月通畅率为 71.8%，1 年通畅率为 62.6%。即时失败率随年龄下降。直径>4.0mm 的动脉发生失败的可能性较小，直径<2.0mm 的动脉发生失败的可能性较大。
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