Azad HEKİMOĞLU, İsmail KIRBAŞ, Onur ERGUN

Disfonksiyone tünelli hemodiyaliz kateterlerinin değişiminde balon anjiyoplasti uygulamasının kateter patensisi üzerine etkisi

Amaç: Disfonksiyone tünelli hemodiyaliz kateterlerinde en sık karşılaşılan sorun fibrin kılıf oluşumudur. Bu durumda kateter patensisini uzatmak amacıyla farklı yöntemler mevcuttur. Bu çalışmada disfonksiyone tünelli hemodiyaliz kataterlerinin balon anjioplasti uygulanarak değişimi ile balon anjioplasti uygulanmadan değişiminin kateter patensisi açısından karşılaştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya disfonksiyone tünelli hemodiyaliz kateteri bulunan 84 hastada yapılan toplam 93 kateter değişim işlemi dahil edildi. Balon anjiyoplasti uygulanarak yapılan 52 kateter değişim işlemi ve balon anjiyoplasti uygulanmadan yapılan 41 kateter değişim işlemi retrospektif olarak değerlendirildi. Her iki grupta değiştirilen kateterlerin 1., 3., 6. ve 12. ayda patensilerine bakıldı. Bulgular: Gruplar arasında yaş, cinsiyet ve kateter lokalizasyonu açısından anlamlı farklılık saptanmadı. Değişimi yapılan tüm tünelli kateterler için ortalama patensi süresi 5,9 ay (1 hafta-29 ay) olarak hesaplandı. Balon anjioplasti uygulanan grupta kateterlerin patensi süresi ortalama 5 ay, balon anjioplasti uygulanmayan grupta ise 7,1 ay olarak hesaplandı (p=0,083). İki grubun patensi süreleri karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı. Sonuç: Disfonksiyone tünelli kateterlerde balon anjiyoplasti uygulanarak yapılan kateter değişimi ile balon anjiyoplasi uygulanmadan yapılan kateter değişiminin kateter patensisi açısından birbirine üstünlüğü saptanmamıştır. Bu gibi hallerde hastanın durumu göz önünde bulundurulup, zararı ve maliyeti daha düşük işlemin seçilmesi daha doğru yaklaşım olacaktır.

Anahtar Kelimeler:

Tünelli hemodiyaliz kateteri, fibrin kılıf, balon anjioplasti

Effect of balloon angioplasty on catheter patency in the replacement of dysfunctional tunneled hemodialysis catheters

Aim: Fibrin sheath formation is the most common problem in dysfunctional tunneled hemodialysis catheters. Different methods are available to prolong catheter patency in such situations. In this study, it was aimed to compare the effect of balloon angioplasty on catheter patency in the replacement of dysfunctional tunneled hemodialysis catheters. Material and Method: A total of 93 catheter exchange procedures in 84 patients with dysfunctional tunneled hemodialysis catheters were included in the study. Fifty-two catheter exchange procedures performed with balloon angioplasty and 41 catheter exchange procedures performed without balloon angioplasty were retrospectively evaluated. Catheter patency in both groups were assessed at 1st, 3rd, 6th and 12th months. Results: There was no significant difference in age, sex and catheter location between the groups. The mean patency time was 5.9 months (1 week-29 months) for all exchanged tunneled catheters. The mean patency duration of the catheters was calculated as 5 months in the balloon angioplasty group and 7.1 months in the group without balloon angioplasty (p=0.083). There was no statistically significant difference in patency duration of two groups. Conclusion: Comparing patency durations of exchanged dysfunctional tunneled catheters, there was no effect of performing balloon angioplasty during the exchange procedure. In such cases, it would be more appropriate to consider the condition of the patient and to choose a less harmful and costly procedure for the patient.

Keywords:

Tunneled hemodialysis catheters, fibrin sheath, balloon angioplasty,

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