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Abstract
Background: Arteriovenous fistula (AVF) stenosis is a common complication among maintenance hemodialysis patients. This study aims to describe clinical features, dialysis parameters and Doppler ultrasound (DUS) parameters of 49 hemodialysis patients with severe AVF stenosis and assess changes in those parameters of 15/49 patients undergoing percutaneous transluminal angioplasty (PTA).
Methods: The study was a longitudinal one carried in Department of Nephrology, Cho Ray hospital from October 2019 to February 2022. A total of 49 patients with severe AVF stenosis (with the degree of stenosis > 50%) confirmed by DUS were selected.
Results: 49 patients (21 males, 42.9%) with a median age of 50 (38 - 640) were included in the study. The median time between dialysis and study enrollment was 4.09 years. 8 patients (16.3%) had edema and collateral circulation on the arm with AVF, 90% had abnormalities of pulse and thrill tests on AVF physical examination. All participants had blood flow rate at the site of stenosis < 500 ml/min estimated by DUS. Inflow stenosis and outflow stenosis occurred in 35/49 cases (71.43%) and 14/49 (28.57%) cases, respectively. 25 patients (51.1%) had urea recirculation ratio > 5%, 4 patients (8.16%) had spKt/v < 1.2. There were 15 patients undergoing PTA with balloon and two of them had stent placement. After PTA procedure, the median assisted AVF patency time was 519 days (93 - 575) and there was improvement in clinical features, dialysis parameters and Doppler parameters.
Conclusion: Clinical assessment, dialysis parameters and Doppler ultrasonographic parameters provide detailed information regarding imaging and function of severe AVF stenosis.
References
Dương Đinh Bảo, Trần Quyết Tiến. Kết quả của can thiệp nội mạch điều trị hẹp, tắc tĩnh mạch trung tâm trên bệnh nhân chạy thận nhân tạo. Tạp Chí Phẫu thuật Tim mạch Và Lồng ngực Việt Nam 2021;31: 27-33.
Abigail T, Tim H. Vascular Ultrasound How, Why, and When. 2nd ed. New York, NY: Churchill Livingstone Elsevier; 2010.
Phạm Văn Hiền, Trần Thị Bích Hương. Chỉ số tái lọc urê ở bệnh nhân chạy thận nhân tạo định kỳ có siêu âm đường dò động tĩnh mạch tự thân không tắc hẹp. Tạp chí Y Học Thành phố Hồ Chí Minh 2022;26(1): 43-50.
Vorwerk D, Konner K, Schurmaan K, Gunther R. A simple trick to facilitate bleeding control after percutaneous hemodialysis fistula and graft interventions. Cardiovasc Intervent Radiol 1997;20(2):159-60.
Aruny J, Lewis C, Cardella J. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access: Standards of Practice Committeeofthe Society ofCardiovascular&Interventional Radiology. J Vasc Interv Radiol 1999;10(4):491–8.
Lok C, Huber T, Lee T. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases 2020;75(4):80-8.
Salman L, Beathard G. Interventional nephrology: Physical examination as a tool for surveillance for the hemodialysis arteriovenous access. Clin J Am Soc Nephrol 2013;8(7):1220-7.
Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. 5th ed. Wolters Kluwer Health 2015.
Thomas A, John T. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006;48(1):2-90.
Rajabi - Jaghargh E, Banerjee R . Combined functional and anatomical diagnostic endpoints for assessing arteriovenous fistula dysfunction. World J Nephrol 2015;4(1):6-18.
Sidhu A, Tan K, Noel - Lamy M, Simons M, Rajan D. Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency? Cardiovasc Intervent Radiol 2016;39(10): 1400-6.
Schmidli J, Widmer M, Basile C, Donato dG, Gallieni M, Gibbons C. Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery 2018;55(6):757-818.
Work J. Role of Access Surveillance and Preemptive Intervention. Seminars in Vascular Surgery 2011; 24(2):137-42.
| Published | 05-01-2025 | |
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| Issue | No. 81 (2022) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.81.17 | |
| Keywords | Hẹp đường dò động tĩnh mạch tự thân, siêu âm doppler, thận nhân tạo định kỳ, chỉ số tái lọc, can thiệp nội mạch. Arteriovenous fistula stenosis, Doppler ultrasound, hemodialysis, percutaneous transluminal angioplasty, dialysis parameters. |
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