Damar Çaplarının Hemodiyaliz için Oluşturulan Arteriovenöz Fistüllerin Olgunlaşma ve Açıklıkları Üzerine Etkileri

Yıl 2017, Cilt: 4 Sayı: 3, 1 - 6, 01.12.2017

Burak Can Depboylu Serkan Yazman Kursad Tosun

Öz

Arteriovenöz fistülün (AVF) primer yetersizliği
ciddi bir sorundur. Yetersizlik oranlarını azaltmak için, damarların
preoperatif ultrasonografik değerlendirilmesi son yıllarda popülerdir. Ancak,
çoğu klinikte ultrasonografik değerlendirme rutin değildir. Ameliyat genellikle
fizik muayeneden sonra yapılmaktadır. Bu çalışmanın amacı primer yetersizlik
nedenlerini, damar çapları ile primer yetersizlik arasındaki ilişkiyi
değerlendirmektir. 01.01.2012-31.12.2015 arasında yapılan AVF oluşturma,
revizyonlar ve kapatmalar dahil olmak üzere 448 operasyon retrospektif olarak
değerlendirildi. Hastalar yaş, cinsiyet, ırk, operasyon yeri, tarafı,
operasyon, nedeni, kullanılan arter, ven, çapları, anastomoz tipi, tril, açık
kalım ve eşlik eden hastalıkları açısından değerlendirildi. Açık kalımlar 10.
günde, 1. ve 6. aylarda, 1. ve 2. yılda kontrol edildi. 448 operasyonun  %86.38’i oluşturma, %3.79’u kapatma ve %9.82’si
revizyondu. En sık revizyon nedeni ve uygulanan prosedür tromboz (%56.81) ve
trombektomiydi. Kapatmaların en sık nedeni iskemiydi (%35.29). Ortalama
brakiyal arter çapı 4.45±0.45 mm ortalama radial arter çapı 2.52±0.42 mm idi.
Ortalama bazilik ven çapı 3.31±0.60 mm ortalama cephalic ven çapı 2.47±0.64 mm
idi. Brakiyal arter çapı 4.45 mm’den (p<0.003) ve cephalic ven çapı 2.15
mm‘den (p<0.005) küçük olan hastalarda, dismatürasyon veya yetersizlik
oranları anlamlı olarak yüksekti. Damarlarınn preoperatif ultrasonografik
değerlendirilmesi, fizik muayene bulguları iyi bile olsa iyi bir seçenektir.
Uzun ömürlü, yeterli bir AVF için minimum 4.45 mm’lik brakial arter, minimum
2.15 mm’lik cephalic ven ve minimum 2.20 mm’lik radial arter çapı olmasını
öneririz. Ayrıca operasyon sonunda tril varlığı da uzun ömürlü, yeterli bir AVF
için önemli bir işarettir. 

Anahtar Kelimeler

Arteriyovenöz Fistül, Damar Açık Kalımı, Hemodiyaliz, Kardiyovasküler Cerrahi Prosedür, Ultrasonografi

The Effects of Vascular Diameters on the Maturation and Patency of the Arteriovenous Fistulas for Hemodialysis

Öz

Primary failure of
arteriovenous fistula (AVF) is a serious problem. For decreasing the failure
rates, pre-operative ultrasonographic evaluation of the target vessels is
popular in recent years. However, in most clinics ultrasonographic evaluation
is not routine. Operation is usually performed after physical examination. The
aim of this study is to evaluate the primary failure reasons and the relation
between vessel diameters and primary failure. 448 operations, including AVF
creation, revisions and closures performed between 01.01.2012-31.12.2015 were
evaluated retrospectively. Age, gender, race, site, side, operation, reason(s),
used artery and vein, diameters, anastomosis type, thrill, patency and
co-morbid diseases evaluated. Patencies were controlled on the 10th day, on the
1st, 6th months, 1st and 2nd years. Of the 448 operations, 86.38% was creation,
3.79% was closure and 9.82% were revision. Leading revision reason and
performed procedure was thrombosis (56.81%) and thrombectomy. Leading reason of
closures was ischemia (35.29%). Mean brachial artery diameter was 4.45±0.45 mm
and mean radial artery diameter was 2.52±0.42 mm. Mean vein diameters were 3.31±0.60
mm for basilic vein and 2.47±0.64 mm for cephalic vein. In patients with less
than diameter of 4.45 mm for brachial artery (p<0.003) and less than
diameter of 2.15 mm for cephalic vein (p<0.005), dysmaturation or failure
rates were significantly higher. Preoperative ultrasonographic evaluation of
the vessels is a good choice even if the physical examination of the patient is
good. We recommend min 4.45 mm brachial artery, min 2.15 mm cephalic vein and min
2.20 mm radial artery diameter. Presence of thrill at the end of the AVF
creation is an important marker for an adequate, long lasting AVF. 

Anahtar Kelimeler

Hemodialysis, Ultrasonography, Arteriovenous Fistulas, Cardiovascular Surgical Procedure, Vascular Patency

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