Burak Can DEPBOYLU, Serkan YAZMAN, Kursad TOSUN

Damar Çaplarının Hemodiyaliz için Oluşturulan Arteriovenöz Fistüllerin Olgunlaşma ve Açıklıkları Üzerine Etkileri

Arteriovenöz fistülün (AVF) primer yetersizliği ciddi bir sorundur. Yetersizlik oranlarını azaltmak için, damarların preoperatif ultrasonografik değerlendirilmesi son yıllarda popülerdir. Ancak, çoğu klinikte ultrasonografik değerlendirme rutin değildir. Ameliyat genellikle fizik muayeneden sonra yapılmaktadır. Bu çalışmanın amacı primer yetersizlik nedenlerini, damar çapları ile primer yetersizlik arasındaki ilişkiyi değerlendirmektir. 01.01.2012-31.12.2015 arasında yapılan AVF oluşturma, revizyonlar ve kapatmalar dahil olmak üzere 448 operasyon retrospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, ırk, operasyon yeri, tarafı, operasyon, nedeni, kullanılan arter, ven, çapları, anastomoz tipi, tril, açık kalım ve eşlik eden hastalıkları açısından değerlendirildi. Açık kalımlar 10. günde, 1. ve 6. aylarda, 1. ve 2. yılda kontrol edildi. 448 operasyonun %86.38’i oluşturma, %3.79’u kapatma ve %9.82’si revizyondu. En sık revizyon nedeni ve uygulanan prosedür tromboz (%56.81) ve trombektomiydi. Kapatmaların en sık nedeni iskemiydi (%35.29). Ortalama brakiyal arter çapı 4.45±0.45 mm ortalama radial arter çapı 2.52±0.42 mm idi. Ortalama bazilik ven çapı 3.31±0.60 mm ortalama cephalic ven çapı 2.47±0.64 mm idi. Brakiyal arter çapı 4.45 mm’den (p<0.003) ve cephalic ven çapı 2.15 mm‘den (p<0.005) küçük olan hastalarda, dismatürasyon veya yetersizlik oranları anlamlı olarak yüksekti. Damarlarınn preoperatif ultrasonografik değerlendirilmesi, fizik muayene bulguları iyi bile olsa iyi bir seçenektir. Uzun ömürlü, yeterli bir AVF için minimum 4.45 mm’lik brakial arter, minimum 2.15 mm’lik cephalic ven ve minimum 2.20 mm’lik radial arter çapı olmasını öneririz. Ayrıca operasyon sonunda tril varlığı da uzun ömürlü, yeterli bir AVF için önemli bir işarettir.

Anahtar Kelimeler:

Arteriyovenöz Fistül, Damar Açık Kalımı, Hemodiyaliz, Kardiyovasküler Cerrahi Prosedür, Ultrasonografi

The Effects of Vascular Diameters on the Maturation and Patency of the Arteriovenous Fistulas for Hemodialysis

Primary failure of arteriovenous fistula (AVF) is a serious problem. For decreasing the failure rates, pre-operative ultrasonographic evaluation of the target vessels is popular in recent years. However, in most clinics ultrasonographic evaluation is not routine. Operation is usually performed after physical examination. The aim of this study is to evaluate the primary failure reasons and the relation between vessel diameters and primary failure. 448 operations, including AVF creation, revisions and closures performed between 01.01.2012-31.12.2015 were evaluated retrospectively. Age, gender, race, site, side, operation, reason(s), used artery and vein, diameters, anastomosis type, thrill, patency and co-morbid diseases evaluated. Patencies were controlled on the 10th day, on the 1st, 6th months, 1st and 2nd years. Of the 448 operations, 86.38% was creation, 3.79% was closure and 9.82% were revision. Leading revision reason and performed procedure was thrombosis (56.81%) and thrombectomy. Leading reason of closures was ischemia (35.29%). Mean brachial artery diameter was 4.45±0.45 mm and mean radial artery diameter was 2.52±0.42 mm. Mean vein diameters were 3.31±0.60 mm for basilic vein and 2.47±0.64 mm for cephalic vein. In patients with less than diameter of 4.45 mm for brachial artery (p<0.003) and less than diameter of 2.15 mm for cephalic vein (p<0.005), dysmaturation or failure rates were significantly higher. Preoperative ultrasonographic evaluation of the vessels is a good choice even if the physical examination of the patient is good. We recommend min 4.45 mm brachial artery, min 2.15 mm cephalic vein and min 2.20 mm radial artery diameter. Presence of thrill at the end of the AVF creation is an important marker for an adequate, long lasting AVF.

Keywords:

Hemodialysis, Ultrasonography, Arteriovenous Fistulas, Cardiovascular Surgical Procedure, Vascular Patency,

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