Relevance of a skilled vascular surgeon and optimized facility practices in the long-term patency of arteriovenous fistulas: a prospective study
| Autor: | Maria R. Benegas, Carlos Luna, David Aiziczon, Elvio Demicheli, Noemi Ibalo, Farias Laura, Esteban Siga |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty congenital hereditary and neonatal diseases and abnormalities medicine.medical_treatment Elbow 030232 urology & nephrology Vascular access Arteriovenous fistula Enfermagem em Nefrologia 030204 cardiovascular system & hematology lcsh:RC870-923 Nephrology Nursing 03 medical and health sciences Arteriovenous Shunt Surgical 0302 clinical medicine Forearm Renal Dialysis Fístula Arteriovenosa Diabetes Mellitus medicine Humans Vascular Patency Prospective Studies Treatment Failure cardiovascular diseases Prospective cohort study Aged Surgeons business.industry Original Articles General Medicine Middle Aged medicine.disease lcsh:Diseases of the genitourinary system. Urology Surgery Catheter medicine.anatomical_structure Arteriovenous Fistula Grau de Desobstrução Vascular Kidney Failure Chronic Female Clinical Competence Health Facilities Hemodialysis business Follow-Up Studies |
| Zdroj: | Brazilian Journal of Nephrology, Volume: 41, Issue: 3, Pages: 330-335, Published: 11 APR 2019 Brazilian Journal of Nephrology, Iss 0 (2019) Brazilian Journal of Nephrology v.41 n.3 2019 Jornal Brasileiro de Nefrologia Sociedade Brasileira de Nefrologia (SBN) instacron:SBN |
| Popis: | Introduction: Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively. Methods: This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium. Results: We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003). Conclusions: Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF. Resumo Introdução: Fístulas arteriovenosas (FAV) são os melhores acessos vasculares para hemodiálise, mas sua taxa de falhas permanece alta. Poucos estudos abordaram o papel das habilidades do cirurgião vascular e das práticas hospitalares. Nosso objetivo foi avaliar esses fatores, com a hipótese de que as habilidades do cirurgião e as práticas hospitalares teriam um papel importante nas taxas de falhas primárias e perviedade em 12 meses, respectivamente. Métodos: Este foi um estudo de coorte prospectivo de um único centro, realizado de março de 2005 a março de 2017. Apenas os pacientes incidentes foram incluídos. Um único cirurgião fez todas as FAVs, seja no antebraço (inferior) ou no cotovelo (superior). As definições de acesso vascular estavam de acordo com o Consórcio Norte-Americano de Acesso Vascular. Resultados: Estudamos 113 FAVs (65% inferiores) de 106 pacientes (39% diabéticos, 58% começaram com cateter). O tempo até a primeira conexão foi de 21,5 dias (RI: 14 - 31). Apenas 14 FAV (12,4%) tiveram falha primária e 18 falharam durante o primeiro ano. A taxa de patência funcional primária foi de 80,9% (SE 4,1), enquanto a taxa de permeabilidade primária não assistida, que incluiu FP, foi de 70,6% (4,4). A regressão logística mostrou que o diabetes (OR = 3,3, 95% IC 1,38 - 7,88, p = 0,007) e localização no antebraço (OR = 3,03, 95% IC 1,05 - 8,76, p = 0,04) foram preditores de falha da FAV. A patência das FAVs inferior e superior foi semelhante em não-diabéticos, enquanto a perviedade em diabéticos com FAV inferior foi menor que 50%. (p = 0,003). Conclusões: Nossos resultados sugerem que uma FAV duradoura e adequada é viável em quase todos os pacientes. As habilidades do cirurgião e das práticas hospitalares podem ter um papel importante no resultado a longo prazo da FAV. |
| Databáze: | OpenAIRE |
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