Djajakusumah Teguh Marfen, Hapsari Putie, Nugraha Prapanca, Muhammad Arrayyan, Lukman Kiki
Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Int J Nephrol Renovasc Dis. 2024 Feb 12;17:47-58. doi: 10.2147/IJNRD.S440467. eCollection 2024.
End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications.
This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record.
Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010).
Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.
终末期肾病（ESKD）带来了巨大的经济负担。印度尼西亚的数据显示，每年接受血液透析作为常规治疗的ESKD患者数量不断增加。血管通路的建立和维护在ESKD的管理中至关重要。血液透析常引发的血管并发症很常见，也是住院的主要原因之一。插管并发症范围从轻微血肿到假性动脉瘤急性出血，后者需要紧急外科手术。本研究旨在评估有血管通路插管并发症的ESKD患者的不同临床病理特征以及与这些并发症相关的外科治疗。
本研究为回顾性观察研究。研究对象为印度尼西亚西爪哇一家三级医院血管与血管内外科的ESKD患者。共有121名研究对象。血管插管并发症的临床病理特征和外科治疗从病历中提取。
三种主要血管并发症为破裂性假性动脉瘤64/121（52.9%）、濒发性破裂假性动脉瘤28/121（23.1%）和假性动脉瘤21/121（17.4%）。常见的外科手术为引流静脉结扎47/121（38.8%）、动脉一期修复28/121（23.1%）和动脉补片修复18/121（14.9%）。破裂性假性动脉瘤的出血症状与假性动脉瘤的肿块隆起之间存在显著相关性（p = 0.001）。血管肿块直径、血管缺损大小和血肿与所采取的外科手术类型之间存在显著相关性（p < 0.010）。
破裂、濒发性破裂和假性动脉瘤是ESKD患者血管通路的主要并发症，并且所实施的外科手术与血管肿块大小、缺损及血肿之间存在显著相关性。
