Suhartono R, Rahardjo Harrina Erlianti, Harahap Alida Roswita, Mochtar Chaidir Arif, Muradi Akhmadu, Alwi Idrus, Lydia Aida, Kekalih Aria, Soetikno Vivian, Rustam Raflis
Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Ann Med Surg (Lond). 2022 Aug 18;81:104426. doi: 10.1016/j.amsu.2022.104426. eCollection 2022 Sep.
Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) cause major morbidity and mortality in 10% of the global population with CKD. The most common renal replacement therapy is hemodialysis with arteriovenous fistula (AVF) access. AVF often undergoes maturation failure due to feeding artery and draining vein inadequacy. Mechanical dilatation, such as primary balloon angioplasty (PBA), can overcome AVF maturation failure. The volume flow (VF) and diameter of the draining veins in AVF patients must be known to evaluate the effect of PBA on AVF maturation. This study aims to analyze the impact of PBA on VF and draining vein diameter in ESKD patients undergoing AVF surgery.
A retrospective cohort clinical trial was conducted at our institution. A total of 75 participants had AVF with an arterial diameter >1.5 mm or vein diameter at the AVF creation site of 2-4 mm. The subjects were divided into 2 groups: the intervention group undergoing PBA (n = 36) and the control group, without PBA (n = 39). PBA was performed using a Mustang ballon (3-6 mm, Medtronic). Follow-ups were conducted at 1 week, 2 weeks, and 6 weeks after AVF creation.
Based on the data, the diameter and VF of the draining veins were significantly larger in the intervention group than in the control group (p < 0.001). Furthermore, we found significant differences in the mean diameter and VF of the draining veins between the control and intervention groups at all stages of examination, from preoperatively to 6 weeks postoperatively (p < 0.001). The strength of the analysis was more than 80%.
PBA can increase the diameter and VF of the draining veins in patients with AVF.
慢性肾脏病（CKD）和终末期肾病（ESKD）在全球10%的CKD患者中导致了严重的发病和死亡。最常见的肾脏替代治疗是采用动静脉内瘘（AVF）通路进行血液透析。由于供血动脉和引流静脉不足，AVF常常出现成熟失败。机械扩张，如原发性球囊血管成形术（PBA），可以克服AVF成熟失败。为了评估PBA对AVF成熟的效果，必须了解AVF患者引流静脉的血流量（VF）和直径。本研究旨在分析PBA对接受AVF手术的ESKD患者的VF和引流静脉直径的影响。
在我们机构进行了一项回顾性队列临床试验。共有75名参与者的AVF的动脉直径>1.5毫米或AVF创建部位的静脉直径为2 - 4毫米。受试者分为两组：接受PBA的干预组（n = 36）和未接受PBA的对照组（n = 39）。使用Mustang球囊（3 - 6毫米，美敦力公司）进行PBA。在AVF创建后1周、2周和6周进行随访。
根据数据，干预组引流静脉的直径和VF显著大于对照组（p < 0.001）。此外，我们发现在从术前到术后6周的所有检查阶段，对照组和干预组引流静脉的平均直径和VF存在显著差异（p < 0.001）。分析效能超过80%。
PBA可以增加AVF患者引流静脉的直径和VF。
