Prospective evaluation of failure modes in autogenous radiocephalic wrist access for haemodialysis

被引:148
作者
Tordoir, JHM
Rooyens, P
Dammers, R
van der Sande, FM
de Haan, M
Yo, TI
机构
[1] Univ Hosp Maastricht, Dept Surg, Maastricht, Netherlands
[2] Univ Hosp Maastricht, Dept Nephrol, Maastricht, Netherlands
[3] Univ Hosp Maastricht, Dept Radiol, Maastricht, Netherlands
[4] Med Ctr Zuid Rotterdam, Dept Surg, Rotterdam, Netherlands
关键词
fistulae; haemodialysis; intervention; non-maturation; radiocephalic vascular access;
D O I
10.1093/ndt/18.2.378
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Introduction. Radiocephalic wrist arteriovenous fistulae (RCAVF) are the primary and best option for vascular access for haemodialysis treatment. However, 10-24% of these AVFs fail due directly to thrombosis and non-maturation. In a prospective study, the failure modes of radiocephalic AVFs and the impact of surgical and interventional treatment on fistula outcome were investigated. Methods. The rate of thrombosis and non-maturation was evaluated in 43 RCAVFs. The selection of RCAVF creation was made on preoperatively determined duplex parameters. Fistula function was evaluated post-operatively by clinical examination and non-invasively measured AVF blood flow. A policy of a liberal use of radiological and/or surgical revision of non-functioning RCAVFs was made on the basis of duplex measured blood flow and angiographically detected vessel stenosis. Results. Primary fistula function was achieved in 26 of 43 patients (60%). Non-maturation and thrombosis occurred in 14 (33%) and three (7%) patients, respectively. A total of 12 interventions (PTA 6; surgery 6) were needed, resulting in salvage of eight RCAVFs (47%). The blood flow in functioning AVFs was significantly higher compared to non-functioning AVFs at 1 (754 vs 440 cc/min), 7 (799 vs 524 cc/min) and 42 days (946 vs 532 cc/min) post-operatively. At the end, 34 RCAVFs (79%) became functional as vascular access for haemodialysis treatment. Conclusion. Primary RCAVFs have a high rate of failure. An aggressive approach towards early interventional treatment of these non-functional AVFs is worthwhile and leads to a considerable salvage rate. Early post-operative AVF flow measurement indicates the chance of successful maturation of RCAVF.
引用
收藏
页码:378 / 383
页数:6
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