医学
血液透析
动静脉瘘
血管通路
心力衰竭
内科学
糖尿病
回顾性队列研究
心脏病学
外科
内分泌学
作者
Ilan Rozenberg,Sydney Benchetrit,Michael Raigorodetsky,Simone Fajer,Ali Shnaker,Naomi Nacasch,Yael Einbinder,Tali Zitman‐Gal,Keren Cohen-Hagai
出处
期刊:PubMed
日期:2022-08-01
卷期号:24 (8): 514-519
被引量:1
摘要
Reliable vascular access is a fundamental tool for providing effective hemodialysis. Vascular access dysfunction is associated with increased morbidity and mortality among hemodialysis patients. Current vascular access guidelines strongly recommend creating an arteriovenous fistula (AVF) as the first option; however, a substantial proportion of new AVFs may not be usable.To assess possible predictors of primary and secondary failure of vascular access.This retrospective cohort study included all vascular access sites created at Meir Medical Center from 2006 through 2012. Vascular access site, primary and secondary failure rates, and relevant demographic and clinical data were recorded during 60 months of follow-up.A total of 612 vascular accesses were created and followed for a median of 32 ± 29.4 months. Of these, 490 (80%) were suitable for initiating hemodialysis. Vascular access site was the most important predictor of primary failure but did not predict secondary failure. Co-morbidities such as diabetes mellitus and congestive heart failure, as well as the use of antiplatelet agents did not predict primary or secondary failure. Preoperative vascular mapping using Doppler ultrasonography was performed in 36.4% of cases and was not associated with lower rates of primary or secondary failure.Vascular access site is an important predictor of primary failure. We did not find a benefit of pre-operative vessel mapping or chronic antiplatelet therapy in terms of decreasing primary and secondary failure rates. Physicians should carefully consider the characteristics of the patient and blood vessels before creating vascular access in patients requiring chronic hemodialysis.
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