ABSTRACT
Objective:To explore the risk factors and prevention strategies for autologous arteriovenous fistula failure in 120 maintenance hemodialysis (MHD) patients, and build a regression model.Methods:The clinical data of 120 patients received MHD treatment in Anji County People′s Hospital from January 2020 to February 2022 were retrospectively analyzed, and the selected patients were divided into the failure group (25 cases) and the patency group (95 cases) according to whether they had autologous arteriovenous fistula failure. The clinical data of the two groups were compared. Multivariate Logistic regression analysis method was used to analyze the risk factors of autologous arteriovenous fistula failure in MHD patients. And a Logistic regression model was established to analyze the predictive value.Results:The proportions of women, diabetes and temporary catheter dialysis patients in the failure group were higher than those in the patency group: 56.00% (14/25) vs. 33.68% (32/95), 44.00% (11/25) vs. 13.68% (13/95), 92.00% (23/25) vs. 65.26% (62/95); the time of catheterization, plasma parathyroid hormone, serum albumin (Alb), D-Dimer (D-D), fibrinogen (FIB) and phosphorus were higher than those in the patency group: (47.87 ± 18.43) d vs. (39.65 ± 16.58) d, (439.76 ± 23.45) ng/L vs. (354.54 ± 31.26) ng/L, (43.43 ± 2.54) g/L vs. (39.65 ± 2.31) g/L, (1.13 ± 0.32) mg/L vs. (0.23 ± 0.07) mg/L, (5.64 ± 2.14) g/L vs. (2.76 ± 0.76) g/L, (3.54 ± 1.02) mmol/L vs. (0.76 ± 0.05) mmol/L( P<0.05). The results of multivariate Logistic regression analysis showed that female, concomitant diabetes, temporary catheter dialysis, and high level of serum phosphorus were independent risk factors for autologous arteriovenous fistula failure in MHD patients ( OR = 2.654, 3.077, 3.721, 2.646; P<0.05). Regression equation model was: logit( P) = -12.763 + sex × 0.976 + diabetes × 1.124 + temporary catheter dialysis × 1.314 + level of blood phosphorus × 0.973. When Logistic ( P) > 18.542, the area under the curve (AUC) value for autologous arteriovenous fistula failure prediction in this model was 0.882 (95% CI from 0.811 to 0.934), and with sensitivity of 80.00%, and specificity of 83.16%. Conclusions:Female gender, diabetes mellitus, temporary catheter dialysis, and high blood phosphorus level were independent risk factors for autologous arteriovenous fistula failure in patients with MHD. The model had a good predictive value for failure of autologous arteriovenous fistula in patients with MHD. Corresponding treatment and intervention measures could be used for patients with the above conditions in order to reduce the risk of autologous arteriovenous fistula failure and improve the treatment effect.
ABSTRACT
Objective • To investigate the feasibility of four-dimensional flow MRI (4D flow MRI) in evaluating the hemodynamics of forearm autologous arteriovenous fistula (AVF) in renal dialysis patients. Methods • Forty-five patients from Renal Division of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included. Patients with forearm AVF underwent ultrasonography and MRI. The consistency of 4D flow MRI hemodynamic parameters measured by two radiologists and hemodynamic parameters at the same plane of AVF by 4D flow MRI and ultrasonography were analyzed by paired t test. The morphological parameters of AVF were acquired from black blood sequence, and they were used for Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI. Results • Forty-two patients completed the forearm AVF ultrasonography and MRI successfully. Paired t test showed that the consistency of 4D flow MRI hemodynamic parameters by two radiologists was good (all P=0.000), and all hemodynamic parameters measured by 4D flow MRI and ultrasonography were in good agreement (r=0.292-0.569, all P0.05). Pearson correlation analysis showed that the cephalic venous flow volume of AVF was correlated with the diameter ratio of the cephalic venous to radial artery and the anastomosis area ( r=-0.671, r=0.482, both P<0.05), and the wall shear stress (WSS) near the anastomosis was correlated with the anastomosis angle and wall thickness (r=0.530, r=0.462, both P<0.05). Conclusion • 4D flow MRI can be used to evaluate the hemodynamic parameters of forearm AVF in renal dialysis patients, which can provide a reference for further study of AVF dysfunction.
ABSTRACT
Objective · To investigate the feasibility of four-dimensional flow MRI (4D flow MRI) in evaluating the hemodynamics of forearm autologous arteriovenous fistula (AVF) in renal dialysis patients. Methods · Forty-five patients from Renal Division of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included. Patients with forearm AVF underwent ultrasonography and MRI. The consistency of 4D flow MRI hemodynamic parameters measured by two radiologists and hemodynamic parameters at the same plane of AVF by 4D flow MRI and ultrasonography were analyzed by paired t test. The morphological parameters of AVF were acquired from black blood sequence, and they were used for Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI. Results · Forty-two patients completed the forearm AVF ultrasonography and MRI successfully.Paired t test showed that the consistency of 4D flow MRI hemodynamic parameters by two radiologists was good (all P=0.000), and all hemodynamic parameters measured by 4D flow MRI and ultrasonography were in good agreement (r=0.292-0.569, all P＜0.05) except for the peak flow velocity at anastomosis (r=-0.078, P＞0.05). Pearson correlation analysis showed that the cephalic venous flow volume of AVF was correlated with the diameter ratio of the cephalic venous to radial artery and the anastomosis area (r=-0.671, r=0.482, both P＜0.05), and the wall shear stress (WSS) near the anastomosis was correlated with the anastomosis angle and wall thickness (r=0.530, r=0.462, both P＜0.05). Conclusion · 4D flow MRI can be used to evaluate the hemodynamic parameters of forearm AVF in renal dialysis patients, which can provide a reference for further study of AVF dysfunction.
ABSTRACT
Se realizó un estudio retrospectivo, transversal y descriptivo, para determinar los factores pronósticos sobre la aparición de complicaciones en 300 pacientes con una fístula arteriovenosa creada, atendidos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el trienio 2012- 2015. Entre los resultados principales predominaron el sexo femenino (52,7%), el grupo etario de 51-60 años (55,6%), la hipertensión arterial y la diabetes mellitus como factores de riesgo más comunes, así como la complicación de la FAV a nivel de la muñeca, principalmente en las féminas (34,2 %). Se concluyó que las complicaciones de la fístula arteriovenosa dependen de la presencia o no de factores de riesgo, que pueden ser un marcador negativo que afecta la calidad de vida del paciente y por sí mismos determinan el tiempo de supervivencia.
A retrospective, cross-sectional and descriptive study was carried out, to determine the prediction factors about the emergence of complications in 300 patients with a created arteriovenous fistula, assisted in the Angiology and Vascular Surgery Service of "Saturnino Lora" Teaching Provincial Hospital in Santiago de Cuba during the triennium 2012 - 2015. Among the main results the female sex (52.7%), the 51-60 age group (55.6%), hypertension and diabetes mellitus prevailed as the most common risk factors, as well as the AVF complication at wrist level, mainly in females (34.2%). It was concluded that the arteriovenous fistula complications depend on the presence or not of risk factors that can be a negative marker that affects the patient's life quality and per se determine the survival time.
Subject(s)
Prognosis , Arteriovenous Fistula , Renal Dialysis , ThrombosisABSTRACT
Objective To observe and discusses the application of larger-bore autologous arteriovenous fistula as dialysis pathways in diabetes patients with chronic renal failure. Methods 86 cases of diabetic patients with chronic renal failure were divided into elderly group and non-elderly group. The patients within each group were assigned randomly into Experimental subgroup and control subgroup. Patients underwent wrist autogenous arteriovenous fistula angioplasty.The surgical method was end to side anastomosis between cephalic vein and radial artery. Vertical incision on the radial artery is about 0.7 cm-0.8 cm in the control subgroup and vertical incision on the radial artery is about 1.0 cm-1.1cm in the experimental subgroup. Results The success rate of the operation in experimental subgroup(90.9%, 95.2%) was significantly higher than that of control group(77.3%, 85.7%). The differences were significant (P<0.05). There was no heart failure in the patients underwent surgery. Conclusions In diabetes patients with chronic renal failure need autogenous arteriovenous fistula angioplasty. Properly increasing the diameter of anastomosis can meet the demand on blood flow of hemodialysis without increase complication of heart failure.