Dialysis Access Created Using Double-horseshoe versus Continuous Circular Polypropylene Suture

Chih-Hsien Lee

《童綜合醫學雜誌》 16卷1期 (2022/06) Pp. 8-13

https://doi.org/10.53106/207135922022061601002

摘要

Background: Although haemodialysis with an arteriovenous fistula (AVF) is a common treatment for chronic renal failure, the most common causes of early failure can be attributed to the anastomosis site. This study compared the safety, efficacy, and failure rates of anastomoses created using traditional continuous circular polypropylene suture versus double-horseshoe suture. Methods: This retrospective clinical study used data from general district hospital patients who received either continuous circular polypropylene suture (n = 72; age: 62.6 ± 13.2 years) or double-horseshoe polypropylene suture (n = 185; age: 62.5 ± 12.2 years) between January 2010 and December 2015. Results: Preoperatively, more patients in the double-horseshoe suture group had poor (i.e. ＜ 3 mm) vein quality (circular group 5.6% vs. double-horseshoe group 33%) and poor (i.e., calcification, atheroma formation) artery quality (circular group 1.4% vs. double-horseshoe group 11.4%). The reintervention rates for outflow vein stenosis were 62.5% and 100% in the circular and double-horseshoe groups, respectively. The double-horseshoe group did not require percutaneous transluminal angioplasty (PTA) at the anastomosis site. Conclusions: Switching from circular to double-horseshoe anastomosis resulted in a PTA rate of 0%. Thus, although patients in the double-horseshoe group had no stenosis over the anastomosis site, poor vein quality, and poor artery quality, it was still possible to use a native vessel to create an AVF without increasing PTA rates.

關鍵字

arteriovenous fistula ； dialysis access creation ； percutaneous transluminal angioplasty