Mo Hyejin, Ahn Sanghyun, Han Ahram, Min Sangil, Min Seung-Kee, Jung In Mok
Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Vasc Access. 2023 Nov;24(6):1268-1274. doi: 10.1177/11297298221076582. Epub 2022 Feb 14.
Arteriovenous fistulas (AVFs) are considered the first choice for venous access in end-stage renal disease patients, however, they are also known to have a high primary failure rate (early thrombosis and maturation failure). Of these, the outcome of thrombosed immature AVFs is not well known. This study aimed to investigate the outcome of AVFs with early thrombosis.
Patients who underwent AVF creation from January 2009 to December 2019 at Seoul National University Hospital or Seoul Metropolitan Government - Seoul National University Boramae Medical Center were retrospectively reviewed. Patients who received salvage operations due to early thrombosis within 30 days after access creation were analyzed.
During the study period, a total of 45 patients (radiocephalic 26; brachiocephalic 19) developed early thrombosis and underwent salvage operations. The median age of patients was 61.0 (54.5-69.5) years, and 51.1% were male. The first salvage operation was performed on the median 1.0 (0.0-4.5) day after AVF creation. The most common cause for early thrombosis was venous stenosis (64.4%) and followed by poor arterial inflow (28.9%), especially in radiocephalic AVFs. About 20 AVFs were salvaged to maturation (46.5%). Post-salvage primary patency and secondary patency at 1 year was 72.6% and 100%. In a multivariate logistic regression, significant risk factors for maturation failures were minimum venous outflow diameter ⩽2.5 mm (OR, 4.433; 95% CI, 1.039-18.921; = 0.044) and lower in patients with hypertension (OR, 0.064; 95% CI, 0.006-0.637; = 0.019).
Thrombosed immature AVFs are associated with a high failure rate after salvage operation. However, if the salvage operation is successfully performed, it is associated with an acceptable 1-year outcome.
动静脉内瘘（AVF）被认为是终末期肾病患者静脉通路的首选，但众所周知，其初级失败率较高（早期血栓形成和成熟失败）。其中，血栓形成的未成熟AVF的结局尚不清楚。本研究旨在调查早期血栓形成的AVF的结局。
回顾性分析2009年1月至2019年12月在首尔国立大学医院或首尔市政府 - 首尔国立大学博拉梅医疗中心接受AVF创建的患者。分析在通路创建后30天内因早期血栓形成而接受挽救手术的患者。
在研究期间，共有45例患者（头静脉桡动脉内瘘26例；头臂静脉内瘘19例）发生早期血栓形成并接受了挽救手术。患者的中位年龄为61.0（54.5 - 69.5）岁，男性占51.1%。首次挽救手术在AVF创建后的中位1.0（0.0 - 4.5）天进行。早期血栓形成的最常见原因是静脉狭窄（64.4%），其次是动脉流入不良（28.9%），尤其是在头静脉桡动脉内瘘中。约20例AVF挽救至成熟（46.5%）。挽救后1年的初级通畅率和次级通畅率分别为72.6%和100%。在多因素逻辑回归中，成熟失败的显著危险因素是最小静脉流出直径≤2.5mm（OR，4.433；95%CI，1.039 - 18.921；P = 0.044）以及高血压患者较低（OR，0.064；95%CI，0.006 - 0.637；P = 0.019）。
血栓形成的未成熟AVF在挽救手术后失败率较高。然而，如果成功进行挽救手术，其1年结局是可以接受的。
