Multi-factor Analysis Of Autologous Arteriovenous Fistula

Background and purpose: Hemodialysis is the main means of treatment in patients with uremia in current, autogenous arteriovenous fistula is the primary vascular access in Hemodialysis, the problem that how to establ ish a hemodialysis access and ensure the long-term hemodialysis has been bothering doctors and patients. With the improvement of living standards, the number of elderly patients is increasing,most of them have hypertension?diabetes and other basic diseases, these factors bring a lot of difficulties to the establishment of AVF, how to overcome these difficulties and improve the successful rate become the main research direction. In this study,we discuss the operation method of AVF, summarize the operation experience and the factors that influence the successful rate.Methods:We selected223cases of AVF surgical operation from January2010to December2011.According to the case notes and operative notes, analysed the patient's sex, ages operation sites anastomosing method and hypertension, diabetes,compared the success rate,than analysed the factors which influence the successful rate in old patients. In the end we summarized the common complications and its incidence.The data was processed by statistical software SPSS17.0. count data use X2test.It had statistical significant difference when probability value was less than0.05.Results:AVF operative successful rate was93.72%. Sex, the operation site and anastomosis ing method had no significant effect to the successful rate,P>0.05.Age, hypertension, diabetes had significant effect to the successful rate, P<0.05. The successful rate was decreased obviously in elderly patients, especially who had hypertension and diabetes. In elderly patients, successful rate of snuff-box arteriovenous fistula was lower than forearm, P<0.05; Successful rate of pat ients who had hypertension and diabetes was lower than who had not, P<0.05.About complications, incidence of thrombosis was5.83%,bleeding was0.90%, insufficient blood flow was2.24%, infection was1.35%,CHF was0.45%, the incidence of thrombosis was higher than the others.Conclusion:The success rate in elderly patients and patients who had hypertension and diabetes was obviously lower than the others, and Sex, the operationsite, anastomosising method had no significant effect to the successful rate. The snuff-box arteriovenous fistula and end-side anastomosis was the first choice for hemodialysis patients with the good conditions of the vascular.In elderly patients, in order to improve the successful rate, we suggest to make a preoperative necessary vascular ultrasound for the patients who had hypertension and diabetes. The forearm arteriovenous fistula was the first choice, especially for the poor prognosis of the patients the operation site can even higher.The incidence of thrombosis was higher than the other complications. Be careful nursing,the timely discovery and processing,make efforts to reduce the influence of the thrombosis.