Outcomes of vascular access care and surgery managed by interventional nephrologists: A twelve-year experience
| Autor: | Massimiliano Migliori, Vincenzo Panichi, Fabio Trovato, Giordano Fumagalli, Stefano De Pietro, Carlo Donadio, Francesco Paolo Ferrandello |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Nephrology
medicine.medical_specialty Fistula medicine.medical_treatment 030232 urology & nephrology Transplants Arteriovenous fistula Kaplan-Meier Estimate 030204 cardiovascular system & hematology Single Center Catheterization Nephrologists 03 medical and health sciences Arteriovenous Shunt Surgical 0302 clinical medicine Vascular access surgery Renal Dialysis Internal medicine Humans Medicine Retrospective Studies business.industry Retrospective cohort study General Medicine Hematology medicine.disease Surgery Arteriovenous graft Central venous catheter Hemodialysis Vascular access Catheter Treatment Outcome business |
| Popis: | Background: Optimizing vascular access outcomes is still a challenge, since 30-60% of arteriovenous fistulas fail or do not mature and catheters are widely used in contemporary patients. Methods: This study reports on strategies and outcomes in a single center in which access planning, surgery and maintenance are managed by a team of nephrologists. We retrospectively analyzed 305 fistulas and 61 grafts created in 270 consecutive patients between 2002 and 2013. Results: The percentage of patients receiving a fistula or graft who initiated hemodialysis with a mature access was 68.6%. Among prevalent patients, 71.7% used a fistula, 15.7% a graft and 12.6% a catheter. Rates of primary failure and revision before cannulation were 14.4 and 1.6% for fistulas vs. 4.9 and 3.3% for grafts. After maturation, complications (1.040 vs. 0.188 per patient-year (py)) and interventions (0.743 vs. 0.066 per py) were greater for grafts than for fistulas (p < 0.001). Secondary patency did not significantly differ between grafts and fistulas (median survival 34.8 vs. 57.3 months, p = 0.36), unless primary failures were excluded from Kaplan-Meier analysis (median survival 34.9 vs. 70.9 months, p = 0.03). Conclusions: High fistula prevalence, low access-related morbidity and catheter dependence were achieved using individualized strategies, including mid-forearm or perforating vein fistula creation and selective graft placement in high risk patients. Direct involvement of nephrologists throughout all steps of access care can improve access outcomes, by promoting a patient-centered approach. |
| Databáze: | OpenAIRE |
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