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ABSTRACT
Background. AVF is the vascular access of choice in end stage renal disease patients for allowing hemodialysis. The aim of this study, was to evaluate our pratice in AVF confection. Methods. We realized analytical cross-sectional study, comparing two surgical techniques, end to side (ETS) and Piggy-back in Brazzaville teaching hospital, from June 2016 to December 2020. All patients operate for AVF were included. Epi info 7.2.2.6 was used for statistical analysis. Results. The were 48 and 41 patients respectively in ETS and Piggy-back groups. The mean was 43.3 ± 17.4 years, with a sex-ratio at 1.5. The immediate mean flow across the AVF was 912 ± 518 ml/min, and on maturation it was 1089 ± 512 ml/min (p>0.05). The number of patients receiving secondary intervention was high in ETS group than Piggy-back , respectively 25% and 9.7% p=0.04). Univariate analysis showing female gender, diabetes, and vascular technique are predictive factor of primary fistula failure. However, multivariate analysis, revealed diabetes (HR=2.1 ; 95% IC 1.4-3.2), vascular technique (HR=0.4 ; 95% IC 0.3-0.7) predictive of fistula failure. Fistula rate failure was different between ETS 37.5%, and Piggy-back 14.6% (p=0.03). Piggy-back patients demonstrated significantly decreased juxta-anastomotic stenosis development : early (ETS 13.3%, Piggy-back 3.7%), late (ETS 14%, Piggy-back 2.7%). Juxta-anastomotic stenosis (JAS)would be a major cause of fistula failure. Conclusion. AVF confection is necessary for extrarenal purification. Piggy-back approach may have some impact in JAS development.
RÉSUMÉ
Introduction. Fistule artérioveineuse constitue l’abord vasculaire de choix chez les sujets insuffisants rénaux chromiques au stade terminal. L’objectif de cette étude est d’évaluer notre pratique de confection de fistules. Patients et méthodes. Il s’agit d’une étude transversale analytique, de deux techniques confection de fistules arterioveineuses, end to side (ETS) et Piggy-back au centre hospitalier universitaire de Brazzaville, Juin 2016 et Décembre 2020. Tout patient opéré pour fistules arterioveineuses ont été inclus. L’analyse statistique a été faite avec le logiciel Epi info version 7.2.2.6. Résultats. Au total 48 et 41 patients, respectivement pour le groupe ETS et Piggy-back. L’âge moyen était de 43.3 ± 17.4 ans, sex ratio de 1.5. Le flux post opératoire était de 912 ± 518 ml/min, à maturation de 1089 ± 512 ml/min (p>0.05). La seconde intervention était plus élevée dans le groupe ETS par rapport au Piggy-back, respectivement 25% et 9.7% (p=0.04). L’analyse univariée révèle que le sexe feminin, le diabète, et la technique chirurgicale sont des prédictifs d’échec. Analyse multivariée montre que le diabète (OR=2.1 ; IC 95% 1.4-3.2), technique chirurgicale (OR=0.3 ; IC 95% 0.2-0.7, compared with ETS) sont les deux facteurs prépondérants. Le taux d’échec est plus élevé dans le groupe ETS 37.5% contre 14.6% (p=0.03). Piggy-back montre une dimunition de la sténose juxtanastomotique, par rapport aux ETS, de 13.3% Vs 3.7%, puis 14% Vs 2.7% ; à moyen et long terme. Cause majeure d’échec de maturation serait la sténose juxtanastomotique. Conclusion. Fistule artérioveineuse est capitale pour hémodialyse, Piggy-back semble prévenir la sténose juxtanastomotique.
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References
- Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002 ;35 :603-10.
- NKF-K/DOQI Clinical Practice Guidelines for hemodialysis Adequacy : update 2000. Am J Kidney Dis 2001 ;37 ; Suppl 1 : S7-S64.
- Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis : a randomized controlled trial. JAMA 2008 ;299 :2164-71.
- Beathard GA, Arnold P, Jackson J, Litchfield T, Physician Operators Forum of RMS Lifeline. Aggressive treatment of early fistula failure. Kidney Int 2003 ;64 :1487-94
- Bharat A1, Jaenicke M, Shenoy S. A novel technique of vascular anastomosis to prevent juxta-anastomotic stenosis following arteriovenous fistula creation.J Vasc Surg. 2012 Jan;55(1):274-80.
- Shenoy S, Middleton WD, Windus D, et al: Brachial artery flow measurement as an indicator of forearm native fistula maturation, in Henry ML (ed): Vascular Access for Hemodialysis VII. Chicago, W.L. Gore and Associates, Precept Press, 2001, pp 233-239.
- Shenoy S. Juxta anastomotic stenosis can be prevented. J Vascul Access 2007 ;8 :152-4.
- Cambria RP, Megerman J, Brewster DC, Warnock DF, Hasson J, Abbott WM. The evolution of morphologic and biomechanical changes in reversed and in-situ vein grafts. Ann Surg 1987 ;205 :167-74.
- Shenoy S : Creative surgical solutions for creating and revising AV shunts. J Vasc Acc 2003 ;7 :199-201.
- Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol 2006 ;17 :1112-27.
- Bharat A, Shenoy S. Maturation evaluation for dialysis access. In: Wilson S, editor. Vascular Access Principles and Practice. Philadelphia, PA : Lippincott Williams and Wilkins; 2009.
- Fassiadis N, Morsy M, Siva M, Marsh JE, Makanjuola AD, Chemla ES. Does the surgeon’s experience impact on radiocephalic fistula patency rates ? Semin Dial 2007 ;20 :455-7.
- Kakkos SK1, Kaplanis N2, Papachristou EC2 et al. The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis. Eur J Vasc Endovasc Surg. 2017 Jun ;53(6) :870-878.
- Van Canneyt K, Pourchez T, Eloot S, Guillame C, Bonnet A, Segers P, et al. Hemodynamic impact of anastomosis size and angle in side-to-end arteriovenous fistulae : a computer analysis. J Vasc Access 2010 ;11 :52-8.
References
Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002 ;35 :603-10.
NKF-K/DOQI Clinical Practice Guidelines for hemodialysis Adequacy : update 2000. Am J Kidney Dis 2001 ;37 ; Suppl 1 : S7-S64.
Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis : a randomized controlled trial. JAMA 2008 ;299 :2164-71.
Beathard GA, Arnold P, Jackson J, Litchfield T, Physician Operators Forum of RMS Lifeline. Aggressive treatment of early fistula failure. Kidney Int 2003 ;64 :1487-94
Bharat A1, Jaenicke M, Shenoy S. A novel technique of vascular anastomosis to prevent juxta-anastomotic stenosis following arteriovenous fistula creation.J Vasc Surg. 2012 Jan;55(1):274-80.
Shenoy S, Middleton WD, Windus D, et al: Brachial artery flow measurement as an indicator of forearm native fistula maturation, in Henry ML (ed): Vascular Access for Hemodialysis VII. Chicago, W.L. Gore and Associates, Precept Press, 2001, pp 233-239.
Shenoy S. Juxta anastomotic stenosis can be prevented. J Vascul Access 2007 ;8 :152-4.
Cambria RP, Megerman J, Brewster DC, Warnock DF, Hasson J, Abbott WM. The evolution of morphologic and biomechanical changes in reversed and in-situ vein grafts. Ann Surg 1987 ;205 :167-74.
Shenoy S : Creative surgical solutions for creating and revising AV shunts. J Vasc Acc 2003 ;7 :199-201.
Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol 2006 ;17 :1112-27.
Bharat A, Shenoy S. Maturation evaluation for dialysis access. In: Wilson S, editor. Vascular Access Principles and Practice. Philadelphia, PA : Lippincott Williams and Wilkins; 2009.
Fassiadis N, Morsy M, Siva M, Marsh JE, Makanjuola AD, Chemla ES. Does the surgeon’s experience impact on radiocephalic fistula patency rates ? Semin Dial 2007 ;20 :455-7.
Kakkos SK1, Kaplanis N2, Papachristou EC2 et al. The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis. Eur J Vasc Endovasc Surg. 2017 Jun ;53(6) :870-878.
Van Canneyt K, Pourchez T, Eloot S, Guillame C, Bonnet A, Segers P, et al. Hemodynamic impact of anastomosis size and angle in side-to-end arteriovenous fistulae : a computer analysis. J Vasc Access 2010 ;11 :52-8.