© Borgis - Postępy Nauk Medycznych 2/2013, s. 115-117
Irena Głowińska1, Jerzy Głowiński2, *Jolanta Małyszko1, Michał Myśliwiec1
Przetoka tętniczo-żylna u pacjentów dializowanych w starszym wieku
Arteriovenous fistula in the elderly dialysis patients
1Department of Nephrology and Transplantology, Medical University of Białystok
Head of Department: prof. Michał Myśliwiec, MD, PhD
2Department of Vascular and Transplantation Surgery, Medical University of Białystok
Head of Department: prof. Marek Gacko, MD, PhD
Streszczenie
Wstęp. Starzenie się społeczeństwa i włączanie do hemodializ coraz starszych pacjentów wymagają zapewnienia sprawnego i bezpiecznego dostępu naczyniowego w schorowanej grupie chorych.
Cel pracy. Celem pracy była analiza rodzajów dostępu naczyniowego, wytwarzanego u pacjentów, w zależności od wieku, w szczególności sprawdzenie możliwości wykonania przetok na przedramieniu u chorych po 65. roku życia.
Materiał i metody. Badaniem objęto kolejnych 212 pacjentów zgłoszonych do wytworzenia przetoki av. Pacjentów podzielono na dwie grupy wiekowe: < 65. roku życia i ≥ 65. roku życia.
Wyniki. Operowano 203 pacjentów, analizą objęto 192 dostępy drożne, użyte do hemodializy po pierwotnej operacji. W badanej populacji 118 chorych przekroczyło 65 rok życia. W grupie 1, do 65. roku życia było 45 mężczyzn (61%), grupa 2 liczyła 61 mężczyzn (52%). Ogółem wykonano 122 przetoki na przedramieniu, 58 przetok na ramieniu, ponadto implantowano 12 protez na ramieniu.
Wnioski. Z naszej analizy wynika, że wykonanie dostępu naczyniowego, w postaci przetoki z naczyń własnych, rzadziej przy użyciu protezy, nie podlega dużemu wpływowi wieku pacjenta.
Summary
Introduction. The growing population of elderly and inclusion them into dialysis requires satisfactory and safe vascular access.
Aim. The aim of our study was to analyze different types of arteriovenous fistula (AVF) depending on age specially forearm fistulae in the elderly.
Material and methods. We screened 212 consecutive patients. Patients were divided into two groups: < 65 years of age versus ≥ 65 years of age.
Results. A total of 203 patients were operated. One hundred ninety two AVF used for hemodialysis after first creation were analyzed. In that study population, 118 patients were 65 years or older. In group 1 (patients younger than 65 years old) 45 patients were male (61%) and in group 2-61 patients were males (52%). A total of 122 forearm fistulae, 58 brachial fistulae and 12 brachial PTFE grafts were created.
Conclusions. Our study shows that the creation of native AVF is not limited by the patient’s age.
INTRODUCTION
The population of end stage renal disease patients increases each year in Poland and all over the world. Mean age of patients starting hemodialysis exceeded 60 years. More frequently this type of treatment includes octogenarians (1). The feasibility of arteriovenous fistula in patients older than 65 years old has been studied in recent years (2). The increased frequency of comorbidities like diabetes, hypertension, coronary artery disease, heart failure or arteriosclerosis worsen the prognosis (3).
Clinical problems related to lack of or ineffective vascular access for hemodialysis are major courses of mortality. According to KDOQI and EBPG guidelines native arteriovenous fistula (AVF) is the best vascular access for hemodialysis (4, 5). The main AVF asset compering to central venous catheter (CVC) is longer patency, small risk of complications, low mortality and reduced cost. When the creation of native AVF is impossible synthetic prosthesis may be implanted – arteriovenous graft (AVG). Despite the proven advantages of native AVF synthetic prosthesis provides more than 50% of vascular access (6). Moreover there are suggestions of cardiotoxicity of arteriovenous fistula in elderly population and that it should be replaced by central venous catheter (7). The optimal choice of vascular access remains a controversial issue.
Aim
The aim of our study was to analyze types of different vascular access according to patients age specially a feasibility of forearm fistulae in the elderly.
MATERIAL AND METHODS
Our study is a retrospective analysis of prospectively gathered data on creation of vascular access for haemodialysis.
We screened 212 consecutive patients reported for vascular access. We included patients in a predialysis period or dialysed with CVC or with peritoneal catheter.
Patients with a history of previous arteriovenous fistulae were excluded. Patients were divided into two age groups: one group contains patients less than 65 years old and the second group older than 65 years old. 9 patients with no possibility to create AVF were excluded from further analysis. The same surgeon was qualifying all patients before surgery and was performing the operation. Clinical examination and ultrasound Doppler of arteries and veins of upper extremity were performed. Criteria for forearm fistula were: arterial diameter minimum 2 mm, vein diameter (after tourniquet – 2.5 mm). Most procedures were performed under local anesthesia with intravenous sedation. In a few cases regional plexus block was apply. Anastomosis of radial artery and cephalic vein in a side-to-end fashion using a continuous 6.0 polypropylene suture. In case of brachial artery a standard end-to-side technic was used. When native vessels were inadequate for anastomosis a synthetic prosthesis was implanted. In our study it was the same prosthesis GoretexStrech 6 mm used in all cases. Postoperative assessment of fistula function was performed after 10 days and the next one in 6-8 weeks. As successful we recognized fistulae with at least 30 day functional patency and only those were involved into further analysis.
RESULTS
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Piśmiennictwo
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