Influencing Actors of Successful Establishment of Arteriovenous Fistula With Fine Diameter Vessels in Hemodialysis Patients
Objective To explore the main factors affecting the successful establishment of arteriovenous fistula with small diameter vessels to mature use. Methods 90 cases of patients with end-stage renal disease were chosen as research subjects. Those patients were hospitalized in the Second Nanning People's Hospital,Guangxi Zhuang Autonomous Region from July 2021 to July 2023. Their arteriovenous diameter was<2 mm,which was inspected by B-mode ultrasonography before renal surgery. Prospective studies were adopted. Those patients were based on the size of vessel diameter and divided into two groups,namely Autogenous arteriovenous fistula (artetiovenous fistula,AVF) successful group (n=75) and failure group (n=15). Before the surgery,each group was compared in the following factors:average arterial pressure,arteriovenous diameter,dilatability of the internal diameter of the vein,distance from the skin of the vein,whether the artery was severely calcified,arterial blood flow. In the following six weeks after the surgery,those patients' arteriovenous blood flow and tube diameter of internal fistula have been continually monitored. the success rate of arteriovenous fistula maturation in each group were calculated. Those results were analyzed and affecting factors,lead to the successful establishment of arteriovenous fistula,were put forwarded. Results Among 90 cases of patients with end-stage renal disease,the successful rate of mature arteriovenous fistula was reached to 83.33％ (75/90). Among it,the blood vessel diameter was tested less than 1.0mm before the surgery. Its successful rate was reached to 76.67％ (23/30). The blood vessel diameter 1.0-1.4 mm,its successful rate is reached to 83.33％ (25/30). The blood vessel diameter 1.5-1.9 mm,its successful rate is reached to 90.00％ (27/30). The monofactor analysis shows that the two groups' cephalic vein dilation (P=0.001),venous talar distance (P=0.023),cephalic vein distance (P=0.002),cephalic venous flow (P=0.036),intraoperative atherosclerotic plaque (P=0.011),cephalic venous flow after six weeks of surgery (P<0.001),radial artery blood flow 6 weeks after surgery (P<0.001),brachial artery blood flow after 6 weeks of surgery comparism (P=0.005). The differences had significance for calculating (P<0.05). The multivariate analysis results shows that cephalic vein B=0.912,OR=2.490,95％CI=1.255-4.939),cephalic vein dilation (B=0.152,OR=1.164,95％CI=1.046-1.296) was related dangerous factors resulted in immature internal arteriovenous fistula (P<0.05). Conclusion For patients with end-stage renal disease with small diameter vessels,AVF can be selected,and the AVF maturity rate is higher. The cephalic vein distance and degree of expansion of cephalic vein dilation are the important factors affecting the success of establishing arteriovenous fistula.
万方数据
维普
