Outcome of vascular access surgery for hemodialysis in end-stage renal disease

Tieu Chi Duc1,, Tran Huu Phuoc2
1 Deputy Head of the Department of Thoracic and Vascular Surgery, Gia Dinh People's Hospital
2 Department of Thoracic and Vascular Surgery, Gia Dinh People's Hospital

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Background: Chronic kidney disease is a significant global health burden due to its high incidence and the risk of progression to end-stage renal disease (ESRD), cardiovascular disease, and premature death. Hemodialysis is a common kidney replacement therapy used for patients with ESRD with vascular access surgery crucial. Objectives: This study aims to evaluate the early and mid-term results of vascular access surgery. Subjects and Methods: A retrospective, descriptive case series study. At the TVS Department, Gia Dinh People's Hospital, from January 2020 to December 2022 were included. Results: The study involved 160 patients. Among the 125 patients had been follow up postoperation. The average age was 57 ± 14.5 years. Hypertension in 96.7%, diabetes in 44.7%, heart failure in 18.7%, and 10.6% had other comorbidities. Early results showed access occlusion in 18/141 cases (12.8%). Complications included 3.5% seroma and 2.1% distal limb ischemia syndrome. 77.3% with mature fistulas. Mid-term results showed 3.7% fistula occlusion during hemodialysis, and only 1 case experienced distal limb ischemia syndrome requiring ligation. 6.4% need to support from balloon dilation or branch ligation. Conclusion: Atrioveneous fistula for hemodialysis in ESRD patients has shown good results based on individual clinical examination and preoperative vascular ultrasound.

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Tài liệu tham khảo

1. Mills KT, Xu Y, Zhang W, et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int. Nov 2015;88(5):950-7. doi:10.1038/ki.2015.230
2. Mokdad AH, Forouzanfar MH, Daoud F, et al. Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. Jun 11 2016;387(10036):2383-401. doi:10.1016/S0140-6736(16)00648-6
3. Johansen KL, Chertow GM, Gilbertson DT, et al. US Renal Data System 2022 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. Mar 2023;81(3 Suppl1):A8-A11. doi:10.1053/j.ajkd.2022.12.001
4. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. Jan 2020;75(1 Suppl 1):A6-A7. doi:10.1053/j.ajkd.2019.09.003
5. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. Apr 2020;75(4 Suppl 2):S1-S164. doi:10.1053/j.ajkd.2019.12.001
6. Brown PW. Preoperative radiological assessment for vascular access. Eur J Vasc Endovasc Surg. Jan 2006;31(1):64-9. doi:10.1016/j.ejvs.2005.10.002
7. Venkat Ramanan S, Prabhu RA, Rao IR, Chawla A, Shenoy SV, Nagaraju SP, Bhojaraja MV. Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis. Int Urol Nephrol. Jan 2022;54(1):185-192. doi:10.1007/s11255-021-02908-5
8. Foster BJ, Mitsnefes MM, Dahhou M, Zhang X, Laskin BL. Changes in Excess Mortality from End Stage Renal Disease in the United States from 1995 to 2013. Clin J Am Soc Nephrol. Jan 6 2018;13(1):91-99. doi:10.2215/CJN.04330417
9. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. Nov 17 1966;275(20):1089-92. doi:10.1056/NEJM196611172752002
10. Bashar K, Conlon PJ, Kheirelseid EA, Aherne T, Walsh SR, Leahy A. Arteriovenous fistula in dialysis patients: Factors implicated in early and late AVF maturation failure. Surgeon. Oct 2016;14(5):294-300. doi:10.1016/j.surge.2016.02.001
11. Vassalotti JA, Jennings WC, Beathard GA, et al. Fistula first breakthrough initiative: targeting catheter last in fistula first. Semin Dial. May 2012;25(3):303-10. doi:10.1111/j.1525-139X.2012.01069.x
12. Rothuizen TC, Wong C, Quax PH, van Zonneveld AJ, Rabelink TJ, Rotmans JI. Arteriovenous access failure: more than just intimal hyperplasia? Nephrol Dial Transplant. May 2013;28(5):1085-92. doi:10.1093/ndt/gft068
13. Dember LM, Beck GJ, Allon M, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA. May 14 2008;299(18):2164-71. doi:10.1001/jama.299.18.2164
14. Allon M, Litovsky S, Young CJ, et al. Medial fibrosis, vascular calcification, intimal hyperplasia, and arteriovenous fistula maturation. Am J Kidney Dis. Sep 2011;58(3):437-43. doi:10.1053/j.ajkd.2011.04.018
15. Farber A, Imrey PB, Huber TS, et al. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg. Jan 2016;63(1):163-70 e6. doi:10.1016/j.jvs.2015.07.086
16. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. Oct 2001;60(4):1443-51. doi:10.1046/j.1523-1755.2001.00947.x
17. AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. J Ultrasound Med. Mar 2019;38(3):E4-E18. doi:10.1002/jum.14954
18. Gupta A, Kumar V, Peswani AR, Suresh A. Outcomes of Arteriovenous Fistula Creation in Patients Undergoing Hemodialysis: An Indian Experience. Cureus. Jan 2022;14(1):e20921. doi:10.7759/cureus.20921
19. Lok CE. Fistula first initiative: advantages and pitfalls. Clin J Am Soc Nephrol. Sep 2007;2(5):1043-53. doi:10.2215/CJN.01080307
20. Sultan S, Hynes N, Hamada N, Tawfick W. Patients on hemodialysis are better served by a proximal arteriovenous fistula for long-term venous access. Vasc Endovascular Surg. Nov 2012;46(8):624-34. doi:10.1177/1538574412462635
21. Golebiowski T, Weyde W, Kusztal M, et al. [Vascular access in diabetic patients. Are these patients "difficult"?]. Postepy Hig Med Dosw (Online). Aug 11 2015;69:913-7. Dostep naczyniowy u chorych na cukrzyce. Czy sa to chorzy problematyczni? doi:10.5604/17322693.1164430