XÂM LẤN TỐI THIỂU TRONG ĐIỀU TRỊ SUY CẦU NỐI CHẠY THẬN, HIỆU QUẢ CỦA TÁI THÔNG KHÔNG PHẪU THUẬT Ở NGƯỜI CAO TUỔI TẠI BỆNH VIỆN THỐNG NHẤT

Abstract

Background: Dysfunction of hemodialysis arteriovenous access (AVF) is a very common complication. Surgical treatment has long been proven effective and has been the preferred approach. However, management becomes particularly challenging in older patients with end-stage kidney disease, frailty, and multiple comorbidities. Minimally invasive strategies are therefore a top priority in this population. Accordingly, the effectiveness of non-surgical endovascular (EV) for dysfunctional AVF warrants evaluation. Object and Methods: This descriptive cross-sectional study included 49 patients aged ≥60 years with dysfunctional AVF who underwent EV at Thong Nhat Hospital between 01/2023-06/2025. Clinical characteristics, access-related lesions, technical outcomes, early hemodynamic improvement (access flow and continuous bruit), and in-hospital complications were evaluated. Results and discussion: A high burden of comorbidities was observed, including hypertension (83.7%) and diabetes mellitus (46.9%), malnutrition (BMI <18.5 kg/m²: 26.5%). Immature AVF dysfunction was commonly associated with anastomotic lesions and concomitant thrombosis, whereas mature AVF dysfunction was mainly related to outflow vein stenosis. EV achieved favorable and comparable technical success rates between the two groups (83.3% vs. 86.4%; p>0.05), with marked improvement in access flow and restoration of continuous bruit in more than 90% of cases. The rate of major complications was low, and no procedure-related in-hospital mortality was recorded. Conclusion: EV for dysfunctional AVF in older adults is a safe and effective approach, providing significant early hemodynamic improvement. Given its minimally invasive nature and vessel-preserving advantages, endovascular intervention should be considered a preferred treatment option for managing hemodialysis access dysfunction in the elderly population.