Clinical Study Of Autologous Arteriovenous Fistula In 937 Hemodialysis Patients

Background and Purpose:Hemodialysis is one of the effective ways to treat the end-stage renal disease.A good vascular access is key to the smooth progress of the hemodialysis for ESRD patients.The autologous arteriovenous fistula is the best choice for long-term hemodialysis patients. However,with the extension of the age of hemodialysis patients,the aging of the population,as well as the increasing of the incidence of diabetes,hypertension and peripheral vascular disease year by year,the establishment of the native arteriovenous fistula is more and more difficult,and its related compli- cations are also more and more. Part of arteriovenous fistula failure are major problem for the long-term hemodialysis patients.In this paper, through analyzing the data of 937 (1226 times) hemodialysis patients under- going autologous arteriovenous shunt in our hospital during 15 years,we studyed the influent factors of AVFs success,at the same time evaluated the effects of fistula at different stages,at different sites and in different methods.Methods:We retrospectively investigated the clinical and accessory examin- ational materials of 937 patients with chronic renal failure undergoing arteriovenous fistula for hemodialysis admited to the second affiliated hospital of Da Lian medical university from 1994 to 2008. In terms of timing is divided into three stages:the first phase is from Jan.1994 to Dec.1998,the second phase is from Jan.1999 to Dec.2003 and the third phase is from Jan.2004 to Oct.2008.We respectively recorded each patient's general condition,such as sex,age,primary disease,time of the operation, positions and methods of the operation,24-hour patency rate and accessory examinational results,then analyzed the relationship between these factors the success rate of autologous arteriovenous fistula,and calculate the operative success rate,and compared with the effects of fistula at different stages,at different positions and in different methods.The data was processed by statistical software SPSS 11.0.count data use X2 test.It had statistical significant difference when probability value was less than 0.05.Results:1. AVFs operative success rate in three stages from 1994 to 1998 was 93%,91%,90% respectively;the average success rate was 90.29%.There were no significant differences(P>0.05).2. In the reasons of arteriovenous fistula failure in the three stages,vascular factor(arterial or venous dysfunction) had no significant difference(P>0.05).The ratio of thrombosis factor in the third stage was obviously higher than the first and the second stages,the differences between them had statistical significance(P<0.05).In the clinical factors of arteriovenous fistula failure in different stages,the proportion of the older,diabetes,hypotension and hyperlipidemia patients significantly incre- ased in the third stage,and the difference between them had statistical significance(P<0.05).There were no significant difference in three stages on malnutrition,heart failure and hemoglobin level.3. The clinical dffect between snuff-box arteriovenous fistula and forearm arteriovenous fistula in three stages had no significant difference (P>0.05).4. End-side anastomosis was superior to end-end and side-side anastomosis for arteriovenous fistula,and the difference between them had significance(P<0.05).Conclusion:1. Autologous fistula was the main route for maintenance hemodialysis. Thrombosis is the main reason of fistula failure. Older, diabetes, hypotension and hyperlipidemia can also cause.Controling glucose and lipid before opration,improving operative technique and using appropriate anticoagulant drugs can improve the success rate of fistula. 2. The effectivities of the snuff-box and the forearm had no difference obviously.The snuff-box arteriovenous fistula was the first choice for hemodialysis patients with the good conditions of the vascular.3. End-side anastomosis was the first choice for arteriovenous fistula.