Reasons of the failure of primary arteriovenous fistula surgery in patients with end-stage renal disease

Abstract

Objective To explore the reasons of the failure of primary arteriovenous fistula (AVF)surgery and the preventive measures in patients with end-stage renal disease.Methods A total of 819patients with end-stage renal disease who accepted primary AVF surgery were selected.The data of hemoglobin (Hb),albumin (ALB),cholesterol (CHOL),parathyroid hormone (PTH),fasting blood glucose and blood pressure were collected before surgery,while the diameters of radial artery and cephalic vein were measured by upper extremity vascular ultrasound.Results Seven hundred and forty-two patients with AVF surgery were successful,and 77 patients were failed.The age,the ratio of diabetes,hypertension and blood pressure ＜ 120/70 mm Hg (1 mm Hg =0.133 kPa) in AVF failed patients was higher than that in AVF successful patients[(61.3 ± 13.4) years vs.(45.6 ± 11.2) years,46.8％(36/77) vs.31.7％ (235/742),26.0％ (20/77) vs.19.5％ (145/742),36.4％ (28/77) vs.9.2％ (68/742)],and there was significant difference (P＜0.05 or ＜0.01).The diameters of radial artery and cephalic vein in AVF failed patients was lower than that in AVF successful patients [(1.35 ± 0.64) mm vs.(1.98 ± 0.47) mm,(2.13 ± 0.81)mm vs.(2.47 ± 0.74) mm],and there was significant difference (P＜ 0.01).The level of PTH in AVF failed patients was higher than that in AVF successful patients [(782.39 ± 423.85) ng/L vs.(378.83 ± 352.21) ng/L],and there was significant difference (P ＜ 0.05).Logistic regression analysis showed that blood pressure,diabetes,PTH,the diameters of radial artery and cephalic vein was the risk factor of AVF failed.Conclusion AVF surgery failed is highly correlated with the patient s blood pressure,th primary disease,the vessel diameter, Key words: Nephrosis; Arteriovenous fistula; Renal dialysis