在建立永久性血液透析通路后,先前的中心静脉导管置入和年龄与较早进行干预有关。

Ramtin Talebi, Ramin Talebi, Joshua Chen, Angela Yang, Sanath Patil, Paul J DiMuzio, Babak Abai, Dawn M Salvatore, Michael J Nooromid
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引用次数: 0

摘要

导言:动静脉瘘(AVF)和移植物是终末期肾病患者进行长期血液透析的重要通路。然而,并发症和通路失效往往需要再次介入治疗。在这项研究中,我们旨在明确与永久性血液透析通路早期失败相关的因素,从而为翻修手术提供依据:这项回顾性研究旨在通过多变量生存分析,确定与动静脉滤过和动静脉移植物翻修率增加相关的因素。研究分析了 2005 年至 2022 年间接受初次动静脉通路创建的 136 名患者。研究人员提取了患者的特征,包括年龄、合并症、通路类型和血管解剖结构,并计算了危险比(HR),以确定需要翻修的独立预测因素:共有119名患者被纳入最终队列,平均年龄为55.2岁。超过 40% 的患者曾置入过中心静脉导管,15% 的患者曾置入过 AVF。大部分手术在左侧进行(74%),肱脑瘘最常见(41%)。单变量和多变量 Cox 回归显示,年龄(调整后 HR = 1.02,P = 0.01)和曾置入中心静脉导管(调整后 HR = 1.77,P = 0.01)是提前翻修的独立预测因素,而性别、高血压和糖尿病等其他变量与之无显著关联。即使对混杂因素进行调整,曾置入中心静脉导管的患者翻修风险也增加了77%:讨论:了解成功的长期入路结果的预测因素可为入路类型和替代策略的决策提供指导。在我们的队列中,年龄的增加和曾置入中心静脉导管与永久性血液透析通路失败的时间缩短和需要翻修的风险增加有关。
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Prior central venous catheter placement and age are associated with earlier intervention after permanent hemodialysis access creation.

Introduction: Arteriovenous fistulas (AVFs) and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease. However, complications and access failure often necessitate re-intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures.

Methods: This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision.

Findings: A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders.

Discussion: Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision.

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